Basic Information
Provider Information
NPI: 1578070157
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HADFIELD
FirstName: LEEANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RT(R)(CT)(MR)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 FOOTHILL DR
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841480001
CountryCode: US
TelephoneNumber: 8015821565
FaxNumber:  
Practice Location
Address1: 500 FOOTHILL DR
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841480001
CountryCode: US
TelephoneNumber: 8015821565
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/05/2018
LastUpdateDate: 01/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085B0100X372820UTY Allopathic & Osteopathic PhysiciansRadiologyBody Imaging

No ID Information.


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