Provider Demographics
NPI:1689320483
Name:ANDREASON, TRACI LEE (NP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:ANDREASON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:ANDREASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2399 E CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3910
Mailing Address - Country:US
Mailing Address - Phone:801-647-4479
Mailing Address - Fax:
Practice Address - Street 1:2961 W MAPLE LOOP DR # 104
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5686
Practice Address - Country:US
Practice Address - Phone:801-647-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85279654405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty