Healthcare Provider Details

I. General information

NPI: 1689589194
Provider Name (Legal Business Name): AMANDA SUE THORNTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 UT-112 #106
GRANTSVILLE UT
84029
US

IV. Provider business mailing address

513 COUNTRY CLUB DR
TOOELE UT
84074-9654
US

V. Phone/Fax

Practice location:
  • Phone: 435-264-4164
  • Fax:
Mailing address:
  • Phone: 702-279-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11765267-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: