Provider Demographics
NPI:1659563682
Name:LOFTUS, AMY DAWN (APRN, WHNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DAWN
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:APRN, WHNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-779-6200
Mailing Address - Fax:801-779-6310
Practice Address - Street 1:4403 HARRISON BLVD STE 4815
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3333
Practice Address - Country:US
Practice Address - Phone:801-387-8350
Practice Address - Fax:801-387-8355
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200589-4402367A00000X
UT200589-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063387Medicare PIN