Provider Demographics
NPI:1073908653
Name:ANDERSON, MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:620 S 400 E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3700
Mailing Address - Country:US
Mailing Address - Phone:435-652-4078
Mailing Address - Fax:435-628-6425
Practice Address - Street 1:620 S 400 E
Practice Address - Street 2:SUITE 400
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3700
Practice Address - Country:US
Practice Address - Phone:435-652-4078
Practice Address - Fax:435-628-6425
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9194929-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse