Healthcare Provider Details

I. General information

NPI: 1285214205
Provider Name (Legal Business Name): NOELLE MORTENSEN HAINES A.P.R.N FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 S 2000 E
SALT LAKE CITY UT
84109-1737
US

IV. Provider business mailing address

12433 S FORT ST
DRAPER UT
84020-9363
US

V. Phone/Fax

Practice location:
  • Phone: 301-693-7830
  • Fax:
Mailing address:
  • Phone: 801-576-1086
  • Fax: 801-576-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10216868-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: