Healthcare Provider Details

I. General information

NPI: 1174298178
Provider Name (Legal Business Name): AMANDA DAGGETT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 10/04/2023
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 19TH AVE NW
MINOT ND
58703-8899
US

IV. Provider business mailing address

6301 19TH AVE NW
MINOT ND
58703-8899
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-2950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR40679
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: