Healthcare Provider Details

I. General information

NPI: 1245196682
Provider Name (Legal Business Name): ANDREA ELIZABETH BINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 W SOPHIE LN
WEST HAVEN UT
84401-3795
US

IV. Provider business mailing address

3385 W SOPHIE LN
WEST HAVEN UT
84401-3795
US

V. Phone/Fax

Practice location:
  • Phone: 801-791-7435
  • Fax:
Mailing address:
  • Phone: 801-791-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number11443751-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: