Individual
EMMALINE ELISA HADERLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 N 1900 E, SALT LAKE CITY, UT 84132-0002
(801) 581-7498
Mailing address
1154 S 1300 E, SALT LAKE CITY, UT 84105-1955
(208) 600-0548
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
D2L2E6L2
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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