Provider Demographics
NPI:1447636188
Name:LOVING, ANDREA K (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:LOVING
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 S 700 E STE 201
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3053
Mailing Address - Country:US
Mailing Address - Phone:801-895-8903
Mailing Address - Fax:888-312-5374
Practice Address - Street 1:4400 S 700 E STE 201
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-3053
Practice Address - Country:US
Practice Address - Phone:801-895-8903
Practice Address - Fax:888-312-5374
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77715794405363LP0808X
UT7771579-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000093466Medicare PIN