Healthcare Provider Details

I. General information

NPI: 1902493869
Provider Name (Legal Business Name): HALLE KOGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2020
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

341 E HIDDEN GARDEN LN
SOUTH SALT LAKE UT
84115-3648
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 406-396-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8505126-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: