Provider Demographics
NPI:1043281918
Name:ANDERSON, ROBERT J (FNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 N 1700 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1100
Mailing Address - Country:US
Mailing Address - Phone:801-773-8644
Mailing Address - Fax:
Practice Address - Street 1:2084 N 1700 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1100
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR35587163W00000X
CO35732164W00000X
AK120392363LF0000X
UT10486714-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse