Provider Demographics
NPI:1821368093
Name:HAHN, KEITH ALLAN (APRN)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLAN
Last Name:HAHN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W UNIVERSITY PKWY
Mailing Address - Street 2:SC 221
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6703
Mailing Address - Country:US
Mailing Address - Phone:801-863-6245
Mailing Address - Fax:801-863-7056
Practice Address - Street 1:800 W UNIVERSITY PKWY
Practice Address - Street 2:SC 221
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6703
Practice Address - Country:US
Practice Address - Phone:801-863-6245
Practice Address - Fax:801-863-7056
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275506-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily