Healthcare Provider Details

I. General information

NPI: 1992071559
Provider Name (Legal Business Name): SUMER DAWN ANDERSON PMHNP-BC DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W SEGO LILY DR STE 312
SANDY UT
84070-3643
US

IV. Provider business mailing address

45 W SEGO LILY DR STE 312
SANDY UT
84070-3643
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-9452
  • Fax:
Mailing address:
  • Phone: 801-676-9452
  • Fax: 801-206-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number8172658-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number81726588900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: