Provider Demographics
NPI:1295481687
Name:BARRUS, AMBER JEAN (FNP STUDENTS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:BARRUS
Suffix:
Gender:F
Credentials:FNP STUDENTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12173 S MARGARET PARK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4042
Mailing Address - Country:US
Mailing Address - Phone:801-450-8472
Mailing Address - Fax:
Practice Address - Street 1:12173 S MARGARET PARK DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4042
Practice Address - Country:US
Practice Address - Phone:801-450-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201488-3102163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice