Provider Demographics
NPI:1639934599
Name:MATTHES, SUZANNE MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:MATTHES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 S IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3645
Mailing Address - Country:US
Mailing Address - Phone:801-573-7707
Mailing Address - Fax:
Practice Address - Street 1:45 W SEGO LILY DR STE 312
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3643
Practice Address - Country:US
Practice Address - Phone:801-676-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4797043-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health