MEDICARE: SUZANNE O'ROURKE ROTHBERG WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	6592021-4408	UT

General Provider Information

NPI Number	:	1205140043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE O'ROURKE ROTHBERG WHNP

Provider Business Mailing Address
First Line	:	1115 E 200 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2503
Country	:	US
Telephone Number	:	218-230-4108
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 W 3600 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4715
Country	:	US
Telephone Number	:	801-973-9675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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