Provider Demographics
NPI:1790249373
Name:CASTRO, AMBER LAURA (NP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LAURA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:LAURA
Other - Last Name:NAUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:633 W 2325 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4059
Mailing Address - Country:US
Mailing Address - Phone:801-628-0961
Mailing Address - Fax:
Practice Address - Street 1:2084 N 1700 W STE A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-773-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7349724-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty