Healthcare Provider Details

I. General information

NPI: 1619818986
Provider Name (Legal Business Name): CHANDRA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 N 100 E STE 4B
SPANISH FORK UT
84660-1241
US

IV. Provider business mailing address

1708 S 2940 E
SPANISH FORK UT
84660-8942
US

V. Phone/Fax

Practice location:
  • Phone: 801-804-5682
  • Fax:
Mailing address:
  • Phone: 314-852-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8999489-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: