Healthcare Provider Details

I. General information

NPI: 1588580179
Provider Name (Legal Business Name): AMANDA J FRASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD FL 2
PHOENIX AZ
85032-2122
US

IV. Provider business mailing address

644 E BARBARITA AVE
GILBERT AZ
85234-4601
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-8955
  • Fax:
Mailing address:
  • Phone: 480-347-8955
  • 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: