MEDICARE: ANDREA K LOVING MSN, APRN, FNP-C

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	77715794405	UT
2	363LF0000X	Family Nurse Practitioner	7771579-4405	UT

General Provider Information

NPI Number	:	1447636188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA K LOVING MSN, APRN, FNP-C

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	09/20/2019

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