MEDICARE: SUZANNA LOUISE SLATER AGNP, MSN, RN

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	363L00000X	Nurse Practitioner	14187712-4405	UT

General Provider Information

NPI Number	:	1609673961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA LOUISE SLATER AGNP, MSN, RN

Provider Business Mailing Address
First Line	:	456 E VICTORIA PL
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-3157
Country	:	US
Telephone Number	:	203-640-4429
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 E VICTORIA PL
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-3157
Country	:	US
Telephone Number	:	203-640-4429
Fax Number	:

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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