Individual provider Active NPI

Susan Jan Haug, RN

  • Ambulatory Care Registered Nurse
  • Salt Lake City, UT
National Provider Identifier
1104188846
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care Registered NurseTaxonomy code 163WP2201X
License
199791-3102 Issued in UT
Practice address
Veterans Affairs Medical Ctr
500 Foothill Drive
Salt Lake City, UT 84148-0001
Phone
(801) 582-1565
Fax
(801) 584-2557
NPI assigned
Jun 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Care Registered Nurse 163WP2201X 199791-3102 UT Primary

Addresses

Primary practice location

Veterans Affairs Medical Ctr
500 Foothill Drive
Salt Lake City, UT 84148-0001

Mailing address

Veterans Affairs Medical Ctr
500 Foothill Drive
Salt Lake City, UT 84148-0001
Phone (801) 582-1565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
199791-3102UTMDAmbulatory Care Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1104188846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "VETERANS AFFAIRS MEDICAL CTR",
            "address_2": "500 FOOTHILL DRIVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-582-1565",
            "fax_number": "801-584-2557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VETERANS AFFAIRS MEDICAL CTR",
            "address_2": "500 FOOTHILL DRIVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-582-1565",
            "fax_number": "801-584-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUG",
        "first_name": "SUSAN",
        "middle_name": "JAN",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "UT",
            "license": "199791-3102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.