Provider Demographics
NPI:1447527908
Name:RAMIREZ, ANDREA RENEE (PNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RAMIREZ
Other - Last Name:AGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-4564
Mailing Address - Fax:801-662-4833
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-4564
Practice Address - Fax:801-662-4833
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8172839-4405363LP0200X
AZAP4301363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics