Provider Demographics
NPI:1598993040
Name:HAGGERTY, ERIN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:HAGGERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:619 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1547
Mailing Address - Country:US
Mailing Address - Phone:801-852-9440
Mailing Address - Fax:801-852-9449
Practice Address - Street 1:619 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1547
Practice Address - Country:US
Practice Address - Phone:801-852-9440
Practice Address - Fax:801-852-9449
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349677-4405363LP0808X
CONP 990323363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health