Provider Demographics
NPI:1528223849
Name:HASSELFELD, DIANA (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:HASSELFELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-4205
Mailing Address - Country:US
Mailing Address - Phone:801-973-5053
Mailing Address - Fax:801-973-5059
Practice Address - Street 1:1678 PIONEER RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-4205
Practice Address - Country:US
Practice Address - Phone:801-973-5053
Practice Address - Fax:801-973-5059
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181802-4405364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health