Provider Demographics
NPI:1104513050
Name:BURNETT, HAYLEE ELISABETH
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:ELISABETH
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E 5600 S APT 3
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6281
Mailing Address - Country:US
Mailing Address - Phone:801-791-1022
Mailing Address - Fax:
Practice Address - Street 1:345 W NORTH TEMPLE STREET
Practice Address - Street 2:FLOOR 1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101
Practice Address - Country:US
Practice Address - Phone:801-240-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program