Healthcare Provider Details

I. General information

NPI: 1114704020
Provider Name (Legal Business Name): AMBER LAMPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S MAIN ST
SALT LAKE CITY UT
84101-3176
US

IV. Provider business mailing address

4460 S HIGHLAND DR STE 120
SALT LAKE CITY UT
84124-3550
US

V. Phone/Fax

Practice location:
  • Phone: 801-539-7000
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberFS3-107899
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: