MEDICARE: AMBER BLYTHE BAIRD NP

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	8047598-4405	UT

General Provider Information

NPI Number	:	1831824861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER BLYTHE BAIRD NP

Provider Business Mailing Address
First Line	:	106 N 900 E
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653-5540
Country	:	US
Telephone Number	:	801-836-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 N 900 E
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653-5540
Country	:	US
Telephone Number	:	801-836-7155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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