Healthcare Provider Details

I. General information

NPI: 1447222849
Provider Name (Legal Business Name): PERRINE JOHNSON ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 ETIENNE WAY
SANDY UT
84093-1116
US

IV. Provider business mailing address

PO BOX 307
BOUNTIFUL UT
84011-0307
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-1085
  • Fax: 801-273-4097
Mailing address:
  • Phone: 888-700-6907
  • Fax: 801-294-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2105664405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: