Provider Demographics
NPI:1639105927
Name:QUAAL, SUSAN JEAN (PHD, APRN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:QUAAL
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 B ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2512
Mailing Address - Country:US
Mailing Address - Phone:801-363-1228
Mailing Address - Fax:
Practice Address - Street 1:GEORGE WAHLEN VA MEDICAL CENTER 500 FOOTHILL BOULE
Practice Address - Street 2:CARDIOLOGY MAIL CODE 111-C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005594405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care