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: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 S 22ND AVE STE 100
BOZEMAN MT
59718-7070
US

IV. Provider business mailing address

1819 S 22ND AVE STE 100
BOZEMAN MT
59718-7070
US

V. Phone/Fax

Practice location:
  • Phone: 406-426-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-290970
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: