Provider Demographics
NPI:1346793007
Name:BINGHAM, ANNALEE (FNP)
Entity type:Individual
Prefix:
First Name:ANNALEE
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-2630
Mailing Address - Country:US
Mailing Address - Phone:801-913-4501
Mailing Address - Fax:
Practice Address - Street 1:552 RIDGE LN
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-2630
Practice Address - Country:US
Practice Address - Phone:801-913-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5653069-4405363LF0000X
UT5653069-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily