person
Susan Kelly Niebaum, PMHNP-BC
Child & Adolescent Psychiatric/Mental Health Registered Nurse in South Salt Lake, Utah
NPI 1861165839

Susan Kelly Niebaum is a Child & Adolescent Psychiatric/Mental Health Registered Nurse based in South Salt Lake, UT and is specialized in Psychiatric/Mental Health, Child & Adolescent. Susan Kelly Niebaum practices in South Salt Lake, UT and has the professional credentials of PMHNP-BC. The NPI Number for Susan Kelly Niebaum is 1861165839 and holds a License No. 12585557-4405 (Utah).

The current practice location address for Susan Kelly Niebaum is 408 E Kelsey View Ln, South Salt Lake, UT and can be reached out via phone at 406-212-2177.

Location: 408 E Kelsey View Ln, South Salt Lake, UT, 84115-4979
person
Provider Profile Details
NPI Number
1861165839
Provider Name
Susan Kelly Niebaum
Credential
PMHNP-BC
Provider Entity Type
Individual
Gender
Female
Address
408 E Kelsey View Ln, South Salt Lake, UT, 84115-4979
Phone Number
406-212-2177
Fax Number
Provider Enumeration Date
07/27/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
408 E Kelsey View Ln
City
State
Zip
84115-4979
Phone Number
406-212-2177
Fax Number
person
Provider Business Mailing Address Details
Address
408 E Kelsey View Ln
City
State
Zip
84115-4979
Phone Number
406-212-2177
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Registered Nurse
Speciality
Psychiatric/Mental Health, Child & Adolescent
Taxonomy
License No.
16869 (Montana)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Psychiatric/Mental Health
Taxonomy
License No.
12585557-4405 (Utah)
Definition
Definition to come...
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