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General NPI Number Information
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NPI Number | 1982064622
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Entity Type | Individual
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Provider Name | AMANDA LIVELY FNP
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Gender | Female
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 377 N FAIRGROUNDS RD
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City | PRICE
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State | UT
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Zip | 84501-4241
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Country | US
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Telephone | 435-613-2200
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Fax | 435-613-2201
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Provider Business Mailing Address
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Address Line | PO BOX 1437
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City | PRICE
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State | UT
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Zip | 84501-1437
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Country | US
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Telephone | 435-613-2200
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Fax | 435-613-2201
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP130221
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7946150-4405
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License Number State | UT
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