Most Relevant Information
Provider Data
| NPI Number: | 1003278300 |
| Provider Name: | AMANDA N FAWSON IDMT |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1003X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/25/2016 |
| Last Updated: | 03/25/2016 |
Provider Practice Location
2155 GRANT AVE
APT 241
OGDEN
UT
844011462
Practice Location Phone/Fax
| Phone: | 4358404113 |
| Fax: |
Provider Mailing Location
2155 GRANT AVE
APT 241
OGDEN
UT
844011462
Provider Mailing Phone/Fax
| Phone: | 4358404113 |
| Fax: |