MEDICARE: AMBER DAWN PETERSON 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
1	363LF0000X	Family Nurse Practitioner	8845405-4405	UT
2	163W00000X	Registered Nurse	8845405-3102	UT

General Provider Information

NPI Number	:	1861187817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER DAWN PETERSON FNP-C

Provider Business Mailing Address
First Line	:	140 E 1000 S STE B2
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-4452
Country	:	US
Telephone Number	:	435-515-3030
Fax Number	:	435-515-3434

Provider Business Practice Location Address
First Line	:	140 E 1000 S STE B2
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-4452
Country	:	US
Telephone Number	:	435-515-3030
Fax Number	:	435-515-3434

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	02/09/2026

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Directions to “ AMBER DAWN PETERSON FNP-C” Practice Location

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