Provider Demographics
NPI:1871139972
Name:TREMBLAY, SUZANNE ENOS
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ENOS
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S 400 W APT 406
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1974
Mailing Address - Country:US
Mailing Address - Phone:978-273-2927
Mailing Address - Fax:
Practice Address - Street 1:1051 E 100 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2268
Practice Address - Country:US
Practice Address - Phone:888-854-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT130232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered