=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871139972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE ENOS TREMBLAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2019
-----------------------------------------------------
Last Update Date | 10/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1051 E 100 N
-----------------------------------------------------
City | LINDON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84042-2268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-854-3822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 S 400 W APT 406
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84101-1974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-273-2927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 130232
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------