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NPI Code Detail

MEDICARE: AMBER PEG BOTTARI FNP-C

MEDICARE: AMBER PEG BOTTARI FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner9801396-4405UT

General Provider Information

NPI Number : 1184322844
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER PEG BOTTARI FNP-C
Provider Business Mailing Address
First Line : PO BOX 281386
Second Line :
City : LAMOILLE
State : NV
Zip : 89828-1386
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5373 S GREEN ST
Second Line :
City : MURRAY
State : UT
Zip : 84123-4680
Country : US
Telephone Number : 801-442-2615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 05/07/2026

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