Healthcare Provider Details

I. General information

NPI: 1841981438
Provider Name (Legal Business Name): AMANDA LEANNE MURRAY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 W 2225 S
SYRACUSE UT
84075-9104
US

IV. Provider business mailing address

572 W 2225 S
SYRACUSE UT
84075-9104
US

V. Phone/Fax

Practice location:
  • Phone: 714-423-5049
  • Fax:
Mailing address:
  • Phone: 714-423-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11371754-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11371754-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: