Provider Demographics
NPI:1326439084
Name:HATCH, SUSAN (RNFA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5113
Mailing Address - Country:US
Mailing Address - Phone:760-731-0313
Mailing Address - Fax:760-731-0414
Practice Address - Street 1:2631 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5113
Practice Address - Country:US
Practice Address - Phone:760-731-0313
Practice Address - Fax:760-731-0414
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200707-3102163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1646529OtherCNOR CERT#