Healthcare Provider Details

I. General information

NPI: 1720928245
Provider Name (Legal Business Name): MRS. RONNEKIA SURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 E 5900 S STE 101
MURRAY UT
84107-7256
US

IV. Provider business mailing address

11713 S SHADOW VIEW LN
DRAPER UT
84020-9689
US

V. Phone/Fax

Practice location:
  • Phone: 801-509-5393
  • Fax:
Mailing address:
  • Phone: 337-429-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14265961-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: