Healthcare Provider Details

I. General information

NPI: 1184102212
Provider Name (Legal Business Name): JENNIFER MARIE HADLEY DNP, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5500
US

IV. Provider business mailing address

3471 S 4800 W
WEST HAVEN UT
84401-9643
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-6215
  • Fax:
Mailing address:
  • Phone: 801-391-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number379005-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number379005-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: