Provider Demographics
NPI:1255156972
Name:HALE, SUSAN (RN, MSN AHN, HWNC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:RN, MSN AHN, HWNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 E 3300 S STE 302
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2737
Mailing Address - Country:US
Mailing Address - Phone:385-333-6000
Mailing Address - Fax:
Practice Address - Street 1:2505 E 3300 S STE 302
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84109-2737
Practice Address - Country:US
Practice Address - Phone:385-333-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277700-3102163WC1500X, 2083P0901X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine