Healthcare Provider Details

I. General information

NPI: 1679938831
Provider Name (Legal Business Name): NISHA DENAE ANDERSEN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S MAIN ST
SAINT GEORGE UT
84770-5504
US

IV. Provider business mailing address

652 S MEDICAL CENTER DR STE 300
ST GEORGE UT
84790-7266
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-2671
  • Fax:
Mailing address:
  • Phone: 435-251-3670
  • Fax: 435-251-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6590850-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: