Provider Demographics
NPI:1508870965
Name:ANDERSON, ESME PULLINGER (APRN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:ESME
Middle Name:PULLINGER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:ESME
Other - Middle Name:P
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-FNP-BC
Mailing Address - Street 1:800 W UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5999
Mailing Address - Country:US
Mailing Address - Phone:801-863-8839
Mailing Address - Fax:
Practice Address - Street 1:800 W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5999
Practice Address - Country:US
Practice Address - Phone:801-863-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1700424405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005556769Medicare PIN