Healthcare Provider Details

I. General information

NPI: 1871139972
Provider Name (Legal Business Name): SUZANNE ENOS TREMBLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 E 100 N
LINDON UT
84042-2268
US

IV. Provider business mailing address

360 S 400 W APT 406
SALT LAKE CITY UT
84101-1974
US

V. Phone/Fax

Practice location:
  • Phone: 888-854-3822
  • Fax:
Mailing address:
  • Phone: 978-273-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number130232
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: