Healthcare Provider Details

I. General information

NPI: 1447636188
Provider Name (Legal Business Name): ANDREA K LOVING MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 S 700 E STE 201
MILLCREEK UT
84107-3053
US

IV. Provider business mailing address

4400 S 700 E STE 201
MILLCREEK UT
84107-3053
US

V. Phone/Fax

Practice location:
  • Phone: 801-895-8903
  • Fax: 888-312-5374
Mailing address:
  • Phone: 801-895-8903
  • Fax: 888-312-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7771579-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number77715794405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: