Individual
MRS. SUSAN LAURIE HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078268
SELECT HEALTH #
UT
01
—
44220
PEHP#
UT
01
—
84-1403495
TAX ID #
UT
01
—
841403495HAN
EMIA#
UT
01
—
94-201751-4402
UT STATE #
UT
Enumeration date
07/12/2006
Last updated
06/24/2010
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