Provider Demographics
NPI:1538391917
Name:ATHENA WOMEN'S CLINIC
Entity type:Organization
Organization Name:ATHENA WOMEN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER- OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESME
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:801-362-1682
Mailing Address - Street 1:1407 N STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2545
Mailing Address - Country:US
Mailing Address - Phone:801-863-8876
Mailing Address - Fax:801-863-7056
Practice Address - Street 1:1407 N STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2545
Practice Address - Country:US
Practice Address - Phone:801-863-8876
Practice Address - Fax:801-863-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1700424405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty