Healthcare Provider Details

I. General information

NPI: 1497530422
Provider Name (Legal Business Name): HALEY MUGLESTON WEST RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

263 N 300 W APT 22
PROVO UT
84601-6724
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5325
  • Fax:
Mailing address:
  • Phone: 541-232-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number13543323-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: