MEDICARE: SUNRISE PSYCHIATRY AND WELLNESS PLLC

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
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1720940547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PSYCHIATRY AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	5526 W 13400 S # 345
Second Line	:
City	:	HERRIMAN
State	:	UT
Zip	:	84096-6919
Country	:	US
Telephone Number	:	385-458-8572
Fax Number	:	888-496-9135

Provider Business Practice Location Address
First Line	:	1272 WEST 12700 SOUTH
Second Line	:	SUITE C
City	:	RIVERTON
State	:	UT
Zip	:	84065
Country	:	US
Telephone Number	:	385-458-8572
Fax Number	:	888-496-9135

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER HAWK
Credential	:	APRN
Telephone Number	:	385-458-8572

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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