Healthcare Provider Details

I. General information

NPI: 1710811658
Provider Name (Legal Business Name): STEPHANIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W 200 N STE 300
ST GEORGE UT
84770-4505
US

IV. Provider business mailing address

474 W 200 N STE 300
ST GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-5606
  • Fax: 435-986-8700
Mailing address:
  • Phone: 435-634-5606
  • Fax: 435-986-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5485078-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: