Healthcare Provider Details

I. General information

NPI: 1336493709
Provider Name (Legal Business Name): MONICA L HATCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 MEDICAL DR STE 100
OGDEN UT
84403-2316
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-8900
  • Fax: 801-387-8920
Mailing address:
  • Phone:
  • Fax: 801-825-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5680506-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5680506-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: