Healthcare Provider Details

I. General information

NPI: 1043889454
Provider Name (Legal Business Name): LAUREN JESSICA HANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

IV. Provider business mailing address

85 N MEDICAL DR
SALT LAKE CITY UT
84112-1100
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-5458
  • Fax:
Mailing address:
  • Phone: 801-587-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number125.079014
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number14288647-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: