Provider Demographics
NPI:1750368718
Name:WEST, SUSANNA BEAN (CRNA)
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:BEAN
Last Name:WEST
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-7060
Mailing Address - Country:US
Mailing Address - Phone:214-498-0233
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER PARK DR STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-437-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10652098-8901367500000X
COC.APN.0004131-C-CRNA367500000X
TX609788367500000X
NVCRNA000363367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164811502Medicaid
NV1750368718Medicaid
NVEG355XMedicare PIN
Q14009Medicare UPIN
TX8D2145Medicare ID - Type Unspecified606K
NV1750368718Medicaid
NVEG355YMedicare PIN