1356682553 NPI number — MRS. ANDREA LEE DRIGGS W.H.N.P.

Table of content: MRS. ANDREA LEE DRIGGS W.H.N.P. (NPI 1356682553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356682553 NPI number — MRS. ANDREA LEE DRIGGS W.H.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRIGGS
Provider First Name:
ANDREA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
W.H.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356682553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 N 300 W
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84604-3344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-357-7377
Provider Business Mailing Address Fax Number:
801-357-7378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 N 300 W
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-3344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-357-7377
Provider Business Practice Location Address Fax Number:
801-357-7378
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  323158-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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