Healthcare Provider Details

I. General information

NPI: 1972482339
Provider Name (Legal Business Name): AMANDA R CHARETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 KEMP AVE SE
DEVILS LAKE ND
58301-3990
US

IV. Provider business mailing address

1321 KEMP AVE SE
DEVILS LAKE ND
58301-3990
US

V. Phone/Fax

Practice location:
  • Phone: 701-230-9705
  • Fax:
Mailing address:
  • Phone: 701-230-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: