Healthcare Provider Details

I. General information

NPI: 1396579926
Provider Name (Legal Business Name): RACHEL ANDERSON RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 S 200 E
SOUTH SALT LAKE UT
84115-4519
US

IV. Provider business mailing address

3462 S 200 E
SOUTH SALT LAKE UT
84115-4519
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-1539
  • Fax:
Mailing address:
  • Phone: 801-358-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number12180479-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: