Southerland, Andrea Graham

Southerland, Andrea Graham is an individual health care provider with primary practice located at 1420 W 12600 S Ste 102 , Riverton UT 84065-7080. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Southerland, Andrea Graham can be contacted via phone (801) 254-4600.

Contact Information

Primary practice address
1420 W 12600 S Ste 102 Riverton UT 84065-7080
Phone: (801) 254-4600
Fax: (801) 254-9670
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4552609-4405 Utah

Profile Details

NPI number 1932353380
LBN Legal business name Southerland, Andrea Graham
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 12th, 2008
Last updated Jun 5th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932353380 NPPES
Utah Other 1932353380 NPI

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