Healthcare Provider Details

I. General information

NPI: 1821372343
Provider Name (Legal Business Name): AMY JO OFFRET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JO YOUNG CRNA DNP

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 08/19/2022
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N 1100 E
AMERICAN FORK UT
84003-2096
US

IV. Provider business mailing address

170 N 1100 E
AMERICAN FORK UT
84003-2096
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-8224
  • Fax:
Mailing address:
  • Phone: 801-367-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA807A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number284738-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: