Individual
LISA NICOLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1055 N 300 W STE 101, PROVO, UT 84604-3381
(801) 852-3460
(801) 852-3459
Mailing address
3550 N UNIVERSITY AVE STE 250, PROVO, UT 84604-6695
(801) 374-9625
(801) 374-9690
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14242949-1205
UT
2086X0206X
Surgical Oncology Physician
35.149055
OH
2086X0206X
Surgical Oncology Physician
V2686
TX
390200000X
Student in an Organized Health Care Education/Training Program
664589
TX
Other
Enumeration date
06/28/2017
Last updated
08/10/2026
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