Provider Demographics
NPI:1306121132
Name:WALKENHORST, ANDREA (DNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WALKENHORST
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:#3500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-743-4750
Mailing Address - Fax:801-743-4765
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:#3500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-743-4750
Practice Address - Fax:801-743-4765
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350691-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care