Provider Demographics
NPI:1881620714
Name:ANDERSON, BONNIE MINTZ (APRN)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MINTZ
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 1:650 KOMAS DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1229
Mailing Address - Country:US
Mailing Address - Phone:801-585-0394
Mailing Address - Fax:801-581-8979
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:SUITE #200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1229
Practice Address - Country:US
Practice Address - Phone:801-585-0394
Practice Address - Fax:801-581-8979
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT205069-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily