Provider Demographics
NPI:1306380209
Name:STONEHOCKER, SUSAN AHLSTROM (RN, BSN, MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:AHLSTROM
Last Name:STONEHOCKER
Suffix:
Gender:F
Credentials:RN, BSN, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:50 E STATE ST
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0618
Mailing Address - Country:US
Mailing Address - Phone:801-525-5158
Mailing Address - Fax:
Practice Address - Street 1:22 S. STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:801-525-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8750635-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse