1306380209 NPI number — MRS. SUSAN AHLSTROM STONEHOCKER RN, BSN, MS, RD

Table of content: MRS. SUSAN AHLSTROM STONEHOCKER RN, BSN, MS, RD (NPI 1306380209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306380209 NPI number — MRS. SUSAN AHLSTROM STONEHOCKER RN, BSN, MS, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONEHOCKER
Provider First Name:
SUSAN
Provider Middle Name:
AHLSTROM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, MS, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306380209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 618
Provider Second Line Business Mailing Address:
50 E STATE ST
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84025-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-525-5158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S. STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-525-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  8750635-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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