MEDICARE: PERRINE JOHNSON ANDERSON APRN

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	363LG0600X	Gerontology Nurse Practitioner	2105664405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	652558	OTHER	UT	DESERET MUTUAL
2	942938348PA4	OTHER	UT	EDUCATORS MUTUAL
3	107029320101	OTHER	UT	INTERMOUNTAIN HEALTH CARE

General Provider Information

NPI Number	:	1447222849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRINE JOHNSON ANDERSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	888-700-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	2773 ETIENNE WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1116
Country	:	US
Telephone Number	:	801-273-1085
Fax Number	:	801-273-4097

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	11/19/2007

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