Healthcare Provider Details

I. General information

NPI: 1851714976
Provider Name (Legal Business Name): AMY GREENWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 WASHINGTON BLVD
OGDEN UT
84403-1866
US

IV. Provider business mailing address

3243 N 1250 W
PLEASANT VIEW UT
84414-1685
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4470
  • Fax:
Mailing address:
  • Phone: 801-663-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number294888-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: