Healthcare Provider Details

I. General information

NPI: 1538000526
Provider Name (Legal Business Name): AMANDA NICOLE DRAGONETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 W BEAL RD
FLAGSTAFF AZ
86001-3060
US

IV. Provider business mailing address

782 W BEAL RD
FLAGSTAFF AZ
86001-3060
US

V. Phone/Fax

Practice location:
  • Phone: 406-548-5263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: