MEDICARE: JENNIFER W. ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	198045-4405	UT

General Provider Information

NPI Number	:	1194905174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER W. ANDERSON

Provider Business Mailing Address
First Line	:	PO BOX 150173
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84415-0173
Country	:	US
Telephone Number	:	801-479-0601
Fax Number	:

Provider Business Practice Location Address
First Line	:	8006 S MOUNTAIN OAKS DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5921
Country	:	US
Telephone Number	:	801-634-5366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER WILLIAMS ANDERSON
Credential	:	FNP
Telephone Number	:	801-634-5366

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	06/06/2013

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