Individual
AMANDA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SBD, MSP
Contact information
Practice address
6278 S 3975 W, TAYLORSVILLE, UT 84129-1016
(801) 997-0977
Mailing address
6278 S 3975 W, TAYLORSVILLE, UT 84129-1016
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
UT-1533-16397
UT
374J00000X
Doula
Primary
—
—
Other
Enumeration date
04/28/2023
Last updated
04/28/2023
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