Individual
KRISTEN HAACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4100
Mailing address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4100
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
364477-4405
UT
363LN0005X
Critical Care Neonatal Nurse Practitioner
364477-4408
UT
Other
Enumeration date
01/04/2009
Last updated
09/08/2021
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