Individual
FANIA AMBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2082 CASSIDY WAY, EAGLE MOUNTAIN, UT 84005-4630
(801) 687-6469
Mailing address
2082 CASSIDY WAY, EAGLE MOUNTAIN, UT 84005-4630
(801) 687-6469
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
1041S0200S
UT
Other
Enumeration date
09/09/2014
Last updated
09/09/2014
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