Provider Demographics
NPI:1689952301
Name:BOYER, ANNDREA M (PA)
Entity Type:Individual
Prefix:
First Name:ANNDREA
Middle Name:M
Last Name:BOYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNDREA
Other - Middle Name:M
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:58 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2132
Mailing Address - Country:US
Mailing Address - Phone:435-233-7900
Mailing Address - Fax:
Practice Address - Street 1:58 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2132
Practice Address - Country:US
Practice Address - Phone:435-233-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10067144-1206363A00000X
NMPA2012-0066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant