Provider Demographics
NPI:1881344778
Name:ANDERSEN, JODI (WHNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 W DEEP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9621
Mailing Address - Country:US
Mailing Address - Phone:801-391-8736
Mailing Address - Fax:
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR STE 460
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7672
Practice Address - Country:US
Practice Address - Phone:801-200-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374064-3102163WH0200X
UT374064-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT374064-4405OtherSTATE LICENSE