Provider Demographics
NPI:1861029696
Name:ANDERSON, DARIENNE AUTUMN RAE (NP)
Entity Type:Individual
Prefix:
First Name:DARIENNE
Middle Name:AUTUMN RAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7199 N GOLDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6287
Mailing Address - Country:US
Mailing Address - Phone:801-380-9832
Mailing Address - Fax:
Practice Address - Street 1:7199 N GOLDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6287
Practice Address - Country:US
Practice Address - Phone:801-380-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5300380-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care