MEDICARE: SUSAN B HASTINGS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	214662-1206	UT

General Provider Information

NPI Number	:	1073501086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN B HASTINGS PA-C

Provider Business Mailing Address
First Line	:	275 W 200 N STE 7
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1873
Country	:	US
Telephone Number	:	801-546-1300
Fax Number	:	801-546-1301

Provider Business Practice Location Address
First Line	:	275 W 200 N STE 7
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1873
Country	:	US
Telephone Number	:	801-546-1300
Fax Number	:	801-546-1301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	09/16/2013

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Directions to “ SUSAN B HASTINGS PA-C” Practice Location

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