Provider Demographics
NPI:1508378431
Name:WRIGHT, AMBER DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 S STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2694
Mailing Address - Country:US
Mailing Address - Phone:801-664-1234
Mailing Address - Fax:866-422-0808
Practice Address - Street 1:9140 S STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2694
Practice Address - Country:US
Practice Address - Phone:801-664-1234
Practice Address - Fax:866-422-0808
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10567429-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant