Provider Demographics
NPI:1447222849
Name:ANDERSON, PERRINE JOHNSON (APRN)
Entity Type:Individual
Prefix:
First Name:PERRINE
Middle Name:JOHNSON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:888-700-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:2773 ETIENNE WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1116
Practice Address - Country:US
Practice Address - Phone:801-273-1085
Practice Address - Fax:801-273-4097
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2105664405363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT652558OtherDESERET MUTUAL
UT942938348PA4OtherEDUCATORS MUTUAL
UT107029320101OtherINTERMOUNTAIN HEALTH CARE
UT652558OtherDESERET MUTUAL
UT942938348PA4OtherEDUCATORS MUTUAL