Healthcare Provider Details

I. General information

NPI: 1366038093
Provider Name (Legal Business Name): AMY BROOKE MORGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W SEGO LILY DR STE 312
SANDY UT
84070-3643
US

IV. Provider business mailing address

45 W SEGO LILY DR STE 312
SANDY UT
84070-3643
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-9452
  • Fax: 801-206-9734
Mailing address:
  • Phone: 801-676-9452
  • Fax: 801-206-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number181876-3101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: