Healthcare Provider Details

I. General information

NPI: 1518831007
Provider Name (Legal Business Name): ANDREA SPENS LANHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 100 S
ALPINE UT
84004-1643
US

IV. Provider business mailing address

310 E 100 S
ALPINE UT
84004-1643
US

V. Phone/Fax

Practice location:
  • Phone: 801-419-6833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number280708-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: