Provider Demographics
NPI:1245744010
Name:MADSEN, SUSAN KAYE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAYE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4583 W WARM CANYON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5029
Mailing Address - Country:US
Mailing Address - Phone:801-404-0059
Mailing Address - Fax:
Practice Address - Street 1:4583 W WARM CANYON LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5029
Practice Address - Country:US
Practice Address - Phone:801-404-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024110163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health