Provider Demographics
NPI:1285214205
Name:HAINES, NOELLE MORTENSEN (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:MORTENSEN
Last Name:HAINES
Suffix:
Gender:
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W 400 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062
Mailing Address - Country:US
Mailing Address - Phone:385-269-1984
Mailing Address - Fax:801-571-5643
Practice Address - Street 1:627 W 4000 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8754
Practice Address - Country:US
Practice Address - Phone:385-269-1984
Practice Address - Fax:801-571-5643
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10216868-4405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily