Individual
SUSAN JEAN TIETJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
5475 S 500 E, OGDEN, UT 84405-6905
(801) 479-2111
Mailing address
4430 S 2750 W, ROY, UT 84067-8954
(801) 732-2172
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
19010616
CA
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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