Healthcare Provider Details

I. General information

NPI: 1245793249
Provider Name (Legal Business Name): ANDERSON WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9533 S 700 E STE 203
SANDY UT
84070-3456
US

IV. Provider business mailing address

9533 S 700 E STE 203
SANDY UT
84070-3456
US

V. Phone/Fax

Practice location:
  • Phone: 801-792-1034
  • Fax:
Mailing address:
  • Phone: 801-792-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMER DAWN ANDERSON
Title or Position: APRN
Credential: APRN
Phone: 801-676-9452