Healthcare Provider Details

I. General information

NPI: 1235069493
Provider Name (Legal Business Name): CODY SUE ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E 200 N
LOGAN UT
84321-4034
US

IV. Provider business mailing address

3278 S 520 W
NIBLEY UT
84321-6554
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-0750
  • Fax:
Mailing address:
  • Phone: 307-399-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7941529-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: