Provider Demographics
NPI:1588800890
Name:BRUCE, AMANDA J (PNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 N 100 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1502
Mailing Address - Country:US
Mailing Address - Phone:801-592-3987
Mailing Address - Fax:
Practice Address - Street 1:2975 W EXECUTIVE PKWY STE 123
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-9642
Practice Address - Country:US
Practice Address - Phone:801-800-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4916775-4405363LP2300X
SC21878363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care