Provider Demographics
NPI:1730288374
Name:TREVITHICK, SUSAN GALE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GALE
Last Name:TREVITHICK
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:8831 ALPEN WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6105
Mailing Address - Country:US
Mailing Address - Phone:801-943-5261
Mailing Address - Fax:801-584-1298
Practice Address - Street 1:VA SALT LAKE CITY HEALTHCARE SYSTEM MC # 118
Practice Address - Street 2:500 FOOTHILL BOULEVARD
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:801-584-1298
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT189015-3102163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator