Healthcare Provider Details

I. General information

NPI: 1902727050
Provider Name (Legal Business Name): AMANDA MARIE CZARNECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 S KYRENE RD
TEMPE AZ
85284-2197
US

IV. Provider business mailing address

4302 E SEQUOIA TRL
PHOENIX AZ
85044-2715
US

V. Phone/Fax

Practice location:
  • Phone: 480-541-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN168448
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: