Provider Demographics
NPI:1760681787
Name:ANDERSON, VICKIE L (APRN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:ANDERSON
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 1:1159 E 200 N
Mailing Address - Street 2:STE 200
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2022
Mailing Address - Country:US
Mailing Address - Phone:801-756-5209
Mailing Address - Fax:801-756-5200
Practice Address - Street 1:1159 E 200 N STE 200
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2026
Practice Address - Country:US
Practice Address - Phone:801-756-5209
Practice Address - Fax:801-756-5200
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84-193708-4405364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics