Healthcare Provider Details

I. General information

NPI: 1215238530
Provider Name (Legal Business Name): SUSANNA BENAVIDEZ CHAPMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZY B. CHAPMAN PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 S 3200 W TAYLORSVILLE
SALT LAKE CITY UT
84118-2822
US

IV. Provider business mailing address

4745 S 3200 W TAYLORSVILLE
SALT LAKE CITY UT
84118-2822
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-6214
  • Fax:
Mailing address:
  • Phone: 801-964-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7796308-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: