Provider Demographics
NPI:1245580661
Name:NAYLOR, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:DEARDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1660 W ANTELOPE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1172
Mailing Address - Country:US
Mailing Address - Phone:801-820-5414
Mailing Address - Fax:801-820-6913
Practice Address - Street 1:1660 W ANTELOPE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1172
Practice Address - Country:US
Practice Address - Phone:801-820-5414
Practice Address - Fax:801-820-6913
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 1218A363LF0000X
UT5272910-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTEFFECTIVE 1/6/14Medicaid
UTP01448512/DV5339OtherRAIL ROAD MEDICARE-EFF 1/6/14
IDF0812127OtherAANP CERTIFICATION
UTEFFECTIVE 1/6/14Medicaid