Provider Demographics
NPI:1891387163
Name:HAUVER, CIJA LUEL (NP)
Entity Type:Individual
Prefix:
First Name:CIJA
Middle Name:LUEL
Last Name:HAUVER
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 1:2400 S COBBLE TER # 308
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9756
Mailing Address - Country:US
Mailing Address - Phone:208-484-4453
Mailing Address - Fax:
Practice Address - Street 1:35 SKYLINE DR STE 103
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-6773
Practice Address - Country:US
Practice Address - Phone:801-255-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66272363LP0808X, 363L00000X, 363LG0600X
UT12369693-4405363LP0808X, 363L00000X
OR202204361NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12369693-4405OtherSTATE OF UTAH COMMERCE LICENSING
OR202204361NP-PPOtherOREGON STATE BOARD OF NURSING
ID66272OtherIDAHO BOARD OF NURSING