Provider Demographics
NPI:1023108610
Name:VAN HALA, SONJA NADEEN (MD)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:NADEEN
Last Name:VAN HALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2805
Mailing Address - Country:US
Mailing Address - Phone:801-474-3825
Mailing Address - Fax:
Practice Address - Street 1:1138 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2819
Practice Address - Country:US
Practice Address - Phone:801-581-2000
Practice Address - Fax:801-463-0313
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377559-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine