Healthcare Provider Details

I. General information

NPI: 1700774965
Provider Name (Legal Business Name): AMBER DAWN MOSS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 W 1900 S
SYRACUSE UT
84075
US

IV. Provider business mailing address

2348 S 770 W
NIBLEY UT
84321
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-4840
  • Fax:
Mailing address:
  • Phone: 801-721-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11893060-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11893060-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: