Healthcare Provider Details

I. General information

NPI: 1639659345
Provider Name (Legal Business Name): HALEY JO HARWARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY JO OLCOTT

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST STE 320
MURRAY UT
84107-6768
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-2531
  • Fax:
Mailing address:
  • Phone: 801-507-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11561990-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: