Healthcare Provider Details

I. General information

NPI: 1619900339
Provider Name (Legal Business Name): DONALD R HASTIE BC-FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 JORDAN LANDING BLVD 200
WEST JORDAN UT
84084-5610
US

IV. Provider business mailing address

460 W 2600 S
BOUNTIFUL UT
84010-7716
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-1919
  • Fax: 801-260-1441
Mailing address:
  • Phone: 801-660-8687
  • Fax: 866-332-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000990
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2047224405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: