Provider Demographics
NPI:1699485235
Name:MCINTOSH, HALEY MARLENE (FNP-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MARLENE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 E 5600 S STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4824
Mailing Address - Country:US
Mailing Address - Phone:801-689-2592
Mailing Address - Fax:
Practice Address - Street 1:1496 E 5600 S STE 5
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4823
Practice Address - Country:US
Practice Address - Phone:801-689-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10806101-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily