Healthcare Provider Details

I. General information

NPI: 1992377055
Provider Name (Legal Business Name): AMANDA JOYCE DAILEY-HANSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

6462 W MAPLE VALLEY CIR
WEST JORDAN UT
84081-6273
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7000
  • Fax:
Mailing address:
  • Phone: 801-598-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9031879-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9031879-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: