Healthcare Provider Details

I. General information

NPI: 1023708831
Provider Name (Legal Business Name): SADI HASSAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SADIYO HASSAN NP

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 UNIVERSITY VLG # 1022
SALT LAKE CITY UT
84108-3451
US

IV. Provider business mailing address

1022 UNIVERSITY VLG # 1022
SALT LAKE CITY UT
84108-3451
US

V. Phone/Fax

Practice location:
  • Phone: 385-626-9317
  • Fax:
Mailing address:
  • Phone: 209-626-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1023708831
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number116032233102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM10860
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: