Healthcare Provider Details

I. General information

NPI: 1326290503
Provider Name (Legal Business Name): SUZANNE MARIE SMITH CPM LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S STATE ST STE C1
OREM UT
84058-6346
US

IV. Provider business mailing address

230 W 170 N
OREM UT
84057-4645
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-5668
  • Fax: 877-676-8482
Mailing address:
  • Phone: 801-225-5668
  • Fax: 877-676-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number6077924-3400
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: