Provider Demographics
NPI:1164816906
Name:WARD, AMANDA A (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:WARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:348 E 4500 S
Mailing Address - Street 2:STE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8524
Mailing Address - Country:US
Mailing Address - Phone:801-397-6200
Mailing Address - Fax:801-397-6201
Practice Address - Street 1:5740 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-479-7771
Practice Address - Fax:801-479-7795
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT295227-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164816906Medicaid