Healthcare Provider Details

I. General information

NPI: 1922717164
Provider Name (Legal Business Name): AMY L ZIRKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E 600 S STE 100
SALT LAKE CITY UT
84111-3564
US

IV. Provider business mailing address

4460 S HIGHLAND DR
SALT LAKE CITY UT
84124-3543
US

V. Phone/Fax

Practice location:
  • Phone: 888-949-4864
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13041501-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: