Healthcare Provider Details

I. General information

NPI: 1942020490
Provider Name (Legal Business Name): AMANDA BILLS CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 S 900 E
MURRAY UT
84117-5703
US

IV. Provider business mailing address

4905 S 900 E
MURRAY UT
84117-5703
US

V. Phone/Fax

Practice location:
  • Phone: 801-869-1095
  • Fax:
Mailing address:
  • Phone: 801-869-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2437
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: