Provider Demographics
NPI:1114609450
Name:ANDERSON, RACHEL IVIE (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:IVIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 W PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7498
Mailing Address - Country:US
Mailing Address - Phone:385-219-1090
Mailing Address - Fax:
Practice Address - Street 1:167 W PRINCETON DR
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7498
Practice Address - Country:US
Practice Address - Phone:385-219-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108303978900363LF0000X
UT108303974405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily