Provider Demographics
NPI:1750673836
Name:ANDRUS, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 S 700 E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3075
Mailing Address - Country:US
Mailing Address - Phone:801-268-4887
Mailing Address - Fax:801-268-4880
Practice Address - Street 1:4444 S 700 E
Practice Address - Street 2:SUITE 203
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3075
Practice Address - Country:US
Practice Address - Phone:801-268-4887
Practice Address - Fax:801-268-4880
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker