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General NPI Number Information
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NPI Number | 1033653233
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Entity Type | Organization
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Legal Business Name | ANDREA LIFE INVESTMENT ENTERPRISES
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 4400 S 700 E STE 201
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City | MILLCREEK
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State | UT
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Zip | 84107-3053
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Country | US
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Telephone | 801-895-8903
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Fax | 888-312-5374
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Provider Business Mailing Address
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Address Line | 4400 S 700 E STE 201
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City | MILLCREEK
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State | UT
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Zip | 84107-3053
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Country | US
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Telephone | 801-895-8903
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Fax | 888-312-5374
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ANDREA LOVING
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Credential | APRN, FNP-C
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Telephone | 801-792-0218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 77715794405
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License Number State | UT
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