Provider Demographics
NPI:1568773935
Name:DUNN, AMANDA (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E STE 10
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2580
Mailing Address - Country:US
Mailing Address - Phone:801-268-4141
Mailing Address - Fax:801-261-8609
Practice Address - Street 1:5770 S 250 E STE 285
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8194
Practice Address - Country:US
Practice Address - Phone:801-268-2822
Practice Address - Fax:801-268-2832
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1568773935Medicaid
UTU000089220Medicare UPIN