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General NPI Number Information
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NPI Number | 1083532568
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Entity Type | Individual
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Provider Name | AMBER EVE MANOLAKAS DENTINO
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 1875 S REDWOOD RD
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-5112
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Country | US
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Telephone | 727-735-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 32 O ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-3905
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Country | US
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Telephone | 727-735-8385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12047277-4405
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License Number State | UT
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