Provider Demographics
NPI:1134144199
Name:HANSEN, SUSAN LAURIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LAURIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 N MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9746
Mailing Address - Country:US
Mailing Address - Phone:435-865-9222
Mailing Address - Fax:435-586-1467
Practice Address - Street 1:1303 N MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9746
Practice Address - Country:US
Practice Address - Phone:435-865-9222
Practice Address - Fax:435-586-1467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT841403495HANOtherEMIA#
UT078268OtherSELECT HEALTH #
UT84-1403495OtherTAX ID #
UT94-201751-4402OtherUT STATE #
UT44220OtherPEHP#
UT078268OtherSELECT HEALTH #