Provider Demographics
NPI:1992071559
Name:ANDERSON, SUMER DAWN (PMHNP-BC DNP)
Entity type:Individual
Prefix:DR
First Name:SUMER
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PMHNP-BC DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W SEGO LILY DR STE 312
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3643
Mailing Address - Country:US
Mailing Address - Phone:801-676-9452
Mailing Address - Fax:801-206-9734
Practice Address - Street 1:45 W SEGO LILY DR STE 312
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3643
Practice Address - Country:US
Practice Address - Phone:801-676-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8172658-3102163WA0400X
UT81726588900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)