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General NPI Number Information
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NPI Number | 1477091684
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Entity Type | Individual
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Provider Name | HALEY MICHELLE VANDERHILL
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Gender | Female
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 590 S WAKARA WAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1200
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Country | US
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Telephone | 801-587-1272
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N ORANGE ST UNIT A316
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-3938
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Country | US
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Telephone | 414-617-3807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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