Healthcare Provider Details

I. General information

NPI: 1912398470
Provider Name (Legal Business Name): AMY C LLOYD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY C LLOYD CRNA

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 S PETUNIA WAY STE B
SANDY UT
84092-4328
US

IV. Provider business mailing address

1279 E TALBOT DR
KAYSVILLE UT
84037-1293
US

V. Phone/Fax

Practice location:
  • Phone: 425-803-3885
  • Fax:
Mailing address:
  • Phone: 801-927-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4791519-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: