Provider Demographics
NPI:1366038093
Name:MORGAN, AMY BROOKE (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BROOKE
Last Name:MORGAN
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 1:45 W SEGO LILY DR STE 312
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3643
Mailing Address - Country:US
Mailing Address - Phone:801-676-9452
Mailing Address - Fax:801-206-9734
Practice Address - Street 1:45 W SEGO LILY DR STE 312
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3643
Practice Address - Country:US
Practice Address - Phone:801-676-9452
Practice Address - Fax:801-206-9734
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181876-3101163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT181876-3101OtherSTATE OF UTAH