Provider Demographics
NPI:1073501086
Name:HASTINGS, SUSAN B (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W 200 N STE 7
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1873
Mailing Address - Country:US
Mailing Address - Phone:801-546-1300
Mailing Address - Fax:801-546-1301
Practice Address - Street 1:275 W 200 N STE 7
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1873
Practice Address - Country:US
Practice Address - Phone:801-546-1300
Practice Address - Fax:801-546-1301
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT214662-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ05203Medicare UPIN