Healthcare Provider Details

I. General information

NPI: 1922292739
Provider Name (Legal Business Name): SUSAN J. G. HEPWORTH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 300 E
MURRAY UT
84107-6548
US

IV. Provider business mailing address

5770 S 300 E
MURRAY UT
84107-6548
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2831
  • Fax:
Mailing address:
  • Phone: 801-314-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number205976-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: