Healthcare Provider Details

I. General information

NPI: 1053173963
Provider Name (Legal Business Name): DARCY HAAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8479 N 1000 W
NEOLA UT
84053-8405
US

IV. Provider business mailing address

8479 N 1000 W
NEOLA UT
84053
US

V. Phone/Fax

Practice location:
  • Phone: 435-671-2828
  • Fax:
Mailing address:
  • Phone: 435-671-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number5038973-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: