Provider Demographics
NPI:1730654526
Name:VANDUZOR, AMANDA RENA (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENA
Last Name:VANDUZOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W ASCENSION WAY STE 225
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2985
Mailing Address - Country:US
Mailing Address - Phone:801-716-7008
Mailing Address - Fax:888-990-1557
Practice Address - Street 1:434 W ASCENSION WAY STE 225
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2985
Practice Address - Country:US
Practice Address - Phone:801-716-7008
Practice Address - Fax:888-990-1557
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10994220-4405363LF0000X
UT109942204405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily