Provider Demographics
NPI:1003007253
Name:ROYAL, AMY LYN (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:ROYAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2141
Mailing Address - Country:US
Mailing Address - Phone:435-843-2300
Mailing Address - Fax:435-843-2304
Practice Address - Street 1:151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2141
Practice Address - Country:US
Practice Address - Phone:435-843-2300
Practice Address - Fax:435-843-2304
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT311983-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT998877663001Medicaid