MEDICARE: ANDREA ANDERSON DEHART CDCES

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	163WD0400X	Diabetes Educator Registered Nurse	6432766-3102	UT

General Provider Information

NPI Number	:	1336087022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ANDERSON DEHART CDCES

Provider Business Mailing Address
First Line	:	5063 S COTTONWOOD ST STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6772
Country	:	US
Telephone Number	:	801-507-7400
Fax Number	:	801-507-7493

Provider Business Practice Location Address
First Line	:	5063 S COTTONWOOD ST STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6772
Country	:	US
Telephone Number	:	801-507-7400
Fax Number	:	801-507-7493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ ANDREA ANDERSON DEHART CDCES” Practice Location

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