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NPI Code Detail

MEDICARE: AMY C GLENN APRN

MEDICARE:   AMY C GLENN  APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner2115124405UT

General Provider Information

NPI Number : 1194760132
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY C GLENN APRN
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 181 E MEDICAL TOWER DR
Second Line :
City : MURRAY
State : UT
Zip : 84107-4872
Country : US
Telephone Number : 801-314-4500
Fax Number : 801-314-2909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 08/08/2023

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Directions to “ AMY C GLENN APRN” Practice Location

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