Provider Demographics
NPI:1508355280
Name:MERKLEY, ANDREA ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:MERKLEY
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 1:1526 UTE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7575
Mailing Address - Country:US
Mailing Address - Phone:435-602-1918
Mailing Address - Fax:435-731-8109
Practice Address - Street 1:1526 UTE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7575
Practice Address - Country:US
Practice Address - Phone:435-602-1918
Practice Address - Fax:435-731-8109
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8318581-3102163WC0400X
UT8318581-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8318581-3102OtherSTATE OF UTAH