Healthcare Provider Details

I. General information

NPI: 1295992097
Provider Name (Legal Business Name): MICHAEL R ANDERSON RN, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S VINE ST STE 100
CENTENNIAL CO
80121-2740
US

IV. Provider business mailing address

474 W 200 N STE#300
ST GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 303-535-7548
  • Fax:
Mailing address:
  • Phone: 435-634-5600
  • Fax: 435-986-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001330-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6685217-3102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number6685217-3101
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6685217-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: