Provider Demographics
NPI:1376915504
Name:SOLLIS, SUSANNE STODDARD (MS, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:STODDARD
Last Name:SOLLIS
Suffix:
Gender:F
Credentials:MS, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 W PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3216
Mailing Address - Country:US
Mailing Address - Phone:801-785-5100
Mailing Address - Fax:801-785-4597
Practice Address - Street 1:1446 W PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3216
Practice Address - Country:US
Practice Address - Phone:801-785-5100
Practice Address - Fax:801-785-4597
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6558262-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily