Provider Demographics
NPI:1326290503
Name:SMITH, SUZANNE MARIE (CPM LDEM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPM LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 170 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4645
Mailing Address - Country:US
Mailing Address - Phone:801-225-5668
Mailing Address - Fax:877-676-8482
Practice Address - Street 1:560 S STATE ST STE C1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6346
Practice Address - Country:US
Practice Address - Phone:801-225-5668
Practice Address - Fax:877-676-8482
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6077924-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife