Healthcare Provider Details

I. General information

NPI: 1306884614
Provider Name (Legal Business Name): SUSAN E MOHLMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

IV. Provider business mailing address

325 W CENTER ST
SPANISH FORK UT
84660-2060
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7301
  • Fax: 801-798-8513
Mailing address:
  • Phone: 801-798-7301
  • Fax: 801-798-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number189847-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: