Healthcare Provider Details

I. General information

NPI: 1689321275
Provider Name (Legal Business Name): SUZANNE MARIE STRASTERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13408 S 1300 W
RIVERTON UT
84065-5608
US

IV. Provider business mailing address

13408 S 1300 W
RIVERTON UT
84065-5608
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-1215
  • Fax:
Mailing address:
  • Phone: 801-915-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5607037-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number5607037-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: