Provider Demographics
NPI:1861187817
Name:PETERSON, AMBER DAWN (FNP-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 40TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1856
Mailing Address - Country:US
Mailing Address - Phone:801-515-7997
Mailing Address - Fax:385-333-7413
Practice Address - Street 1:475 40TH ST STE 111
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1856
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:385-333-7413
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8845405-4405363LF0000X
UT8845405-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse