MEDICARE: ROBERTA FRANCIS ANDERSON F.N.P.

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	363LF0000X	Family Nurse Practitioner	1685764405	UT

General Provider Information

NPI Number	:	1588823132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA FRANCIS ANDERSON F.N.P.

Provider Business Mailing Address
First Line	:	3065 W 8600 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9626
Country	:	US
Telephone Number	:	801-255-9447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3065 W 8600 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9626
Country	:	US
Telephone Number	:	801-255-9447
Fax Number	:

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

Provider Enumeration Date	:	06/08/2008
Last Update Date	:	06/08/2008

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