Healthcare Provider Details

I. General information

NPI: 1326942236
Provider Name (Legal Business Name): ANDREW CONNER MORTENSEN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 E 1450 S
CLEARFIELD UT
84015-1610
US

IV. Provider business mailing address

2920 S 2700 W
WEST HAVEN UT
84401-9014
US

V. Phone/Fax

Practice location:
  • Phone: 801-728-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number12837148-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: