Provider Demographics
NPI:1215238530
Name:CHAPMAN, SUSANNA BENAVIDEZ (PA)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:BENAVIDEZ
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:B
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:4745 S 3200 W
Mailing Address - Street 2:TAYLORSVILLE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2822
Mailing Address - Country:US
Mailing Address - Phone:801-964-6214
Mailing Address - Fax:
Practice Address - Street 1:4745 S 3200 W
Practice Address - Street 2:TAYLORSVILLE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2822
Practice Address - Country:US
Practice Address - Phone:801-964-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7796308-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical