Healthcare Provider Details

I. General information

NPI: 1598138737
Provider Name (Legal Business Name): AMANDA CHRISTENSEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 400 N
OREM UT
84057-1916
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3570
  • Fax:
Mailing address:
  • Phone: 801-714-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5125891-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: