MEDICARE: HALEY B NELSON FNP, NP-C, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5896884-4405	UT

General Provider Information

NPI Number	:	1548557622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY B NELSON FNP, NP-C, APRN

Provider Business Mailing Address
First Line	:	7353 S 2172 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-3248
Country	:	US
Telephone Number	:	801-703-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	7353 S 2172 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-3248
Country	:	US
Telephone Number	:	801-703-3257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	10/09/2020

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