Provider Demographics
NPI:1407546898
Name:VERHAEGHE, MARY ELIZABETH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:VERHAEGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZZY
Other - Middle Name:
Other - Last Name:VERHAEGHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:151 E MIDVILLAGE BLVD APT 508
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1215
Mailing Address - Country:US
Mailing Address - Phone:512-797-9489
Mailing Address - Fax:
Practice Address - Street 1:1800 NOVELL PL
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6101
Practice Address - Country:US
Practice Address - Phone:801-375-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program