Individual
ANDREA GRAHAM SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1420 W 12600 S STE 102, RIVERTON, UT 84065-7080
(801) 254-4600
(801) 254-9670
Mailing address
1420 W 12600 S STE 102, RIVERTON, UT 84065-7080
(801) 254-4600
(801) 254-9670
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4552609-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932353380
NPI
UT
Enumeration date
11/12/2008
Last updated
06/05/2019
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