Healthcare Provider Details

I. General information

NPI: 1437078052
Provider Name (Legal Business Name): AMANDA NICHOLE DRURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S CHIPETA WAY
SALT LAKE CITY UT
84108-1287
US

IV. Provider business mailing address

295 S CHIPETA WAY
SALT LAKE CITY UT
84108-1287
US

V. Phone/Fax

Practice location:
  • Phone: 714-514-2825
  • Fax:
Mailing address:
  • Phone: 714-514-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number10654201-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number10654201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: