Provider Demographics
NPI:1215115357
Name:ANDERSON, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-2950
Mailing Address - Fax:801-662-2980
Practice Address - Street 1:100 N. MARIO CAPECCHI DRIVE
Practice Address - Street 2:SUITE 2600
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-662-2950
Practice Address - Fax:801-662-2980
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2016-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5039155-4405363LP0200X
SDCP000562363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics