Provider Demographics
NPI:1184322844
Name:BOTTARI, AMBER PEG (FNP-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:PEG
Last Name:BOTTARI
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 1:1190 E SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2544
Mailing Address - Country:US
Mailing Address - Phone:801-971-7170
Mailing Address - Fax:
Practice Address - Street 1:1190 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-2544
Practice Address - Country:US
Practice Address - Phone:801-971-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9801396-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily