Provider Demographics
NPI:1619900339
Name:HASTIE, DONALD R (BC-FNP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:HASTIE
Suffix:
Gender:M
Credentials:BC-FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:460 W 2600 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7716
Mailing Address - Country:US
Mailing Address - Phone:801-660-8687
Mailing Address - Fax:866-332-8067
Practice Address - Street 1:7611 JORDAN LANDING BLVD
Practice Address - Street 2:200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5610
Practice Address - Country:US
Practice Address - Phone:801-260-1919
Practice Address - Fax:801-260-1441
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPN000990363LF0000X
UT2047224405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily