Healthcare Provider Details

I. General information

NPI: 1861143711
Provider Name (Legal Business Name): VENDLA LORENE HATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W STE 212
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-3915
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-2362
  • Fax:
Mailing address:
  • Phone: 801-354-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9508621-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: