MEDICARE: ANDREA ELIZABETH MERKLEY 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	163WC0400X	Case Management Registered Nurse	8318581-3102	UT
2	363LF0000X	Family Nurse Practitioner	8318581-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8318581-3102	OTHER	UT	STATE OF UTAH

General Provider Information

NPI Number	:	1508355280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ELIZABETH MERKLEY APRN

Provider Business Mailing Address
First Line	:	308 E 4500 S STE 100B
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-4057
Country	:	US
Telephone Number	:	385-533-8887
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E 4500 S STE 100B
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-4057
Country	:	US
Telephone Number	:	385-533-8887
Fax Number	:

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	08/21/2024

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