Healthcare Provider Details

I. General information

NPI: 1508708090
Provider Name (Legal Business Name): SUZANNE MARIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E 1300 N
LOGAN UT
84341-2570
US

IV. Provider business mailing address

196 W 300 N
SMITHFIELD UT
84335-1814
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-6500
  • Fax:
Mailing address:
  • Phone: 435-792-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF25-118955
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: