=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447636188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA K LOVING MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2015
-----------------------------------------------------
Last Update Date | 09/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 S 700 E STE 201
-----------------------------------------------------
City | MILLCREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-895-8903
-----------------------------------------------------
Fax | 888-312-5374
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4400 S 700 E STE 201
-----------------------------------------------------
City | MILLCREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-895-8903
-----------------------------------------------------
Fax | 888-312-5374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 77715794405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7771579-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------