MEDICARE: ANDREA LIFE INVESTMENT ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SF0001X	Family Health Clinical Nurse Specialist	77715794405	UT

General Provider Information

NPI Number	:	1033653233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREA LIFE INVESTMENT ENTERPRISES

Provider Business Mailing Address
First Line	:	4400 S 700 E STE 201
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-895-8903
Fax Number	:	888-312-5374

Provider Business Practice Location Address
First Line	:	4400 S 700 E STE 201
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-895-8903
Fax Number	:	888-312-5374

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ANDREA LOVING
Credential	:	APRN, FNP-C
Telephone Number	:	801-792-0218

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	09/30/2019

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