Healthcare Provider Details

I. General information

NPI: 1932060092
Provider Name (Legal Business Name): MICHELLE LYNN ANDERSEN FNP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S, 2295 FOOTHILL DR.
SALT LAKE CITY UT
84109
US

IV. Provider business mailing address

2295 S, 2295 FOOTHILL DR.
SALT LAKE CITY UT
84109
US

V. Phone/Fax

Practice location:
  • Phone: 801-468-3021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8177925-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: