Individual ProviderAmber SullyLicensed Practical NurseNursing Service ProvidersPractice Address2250 N 1700 W, Layton, UT 84041-1140(801) 773-7060PECOS EnrollmentBased on the most recent information from CMS, provider Amber Sully does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:46 AM.Profile DetailsProvider ID1740695741Provider TypeIndividualFull NameSully, AmberCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date6/27/2014Last Updated6/27/2014Contact InformationPractice LocationPractice Address2250 N 1700 W, Layton, UT 84041-1140Phone(801) 773-7060Fax(801) 336-1774Mailing LocationMailing Address2250 N 1700 W, Layton, UT 84041-1140Phone(801) 773-7060Fax(801) 336-1774Provider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense9022621-3101Utah