Healthcare Provider Details

I. General information

NPI: 1144868605
Provider Name (Legal Business Name): SAMANTHA ROBYN ANDERSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

2462 N ALESUND WAY
LEHI UT
84043-5449
US

V. Phone/Fax

Practice location:
  • Phone: 608-695-0168
  • Fax:
Mailing address:
  • Phone: 608-695-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN690124
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number317464
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12727407-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: