Provider Demographics
NPI:1477576981
Name:LEMMON, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LEMMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2042
Mailing Address - Country:US
Mailing Address - Phone:801-274-2262
Mailing Address - Fax:
Practice Address - Street 1:1105 W 1000 N
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84116-2135
Practice Address - Country:US
Practice Address - Phone:801-364-2434
Practice Address - Fax:801-364-2436
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215651-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner