MEDICARE: AMANDA JAYNE KROMER N.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R212789	MD

General Provider Information

NPI Number	:	1417552613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JAYNE KROMER N.P

Provider Business Mailing Address
First Line	:	3070 CRAIN HWY
Second Line	:	STE 101
City	:	WALDORF
State	:	MD
Zip	:	20601
Country	:	US
Telephone Number	:	301-645-3556
Fax Number	:	301-645-3932

Provider Business Practice Location Address
First Line	:	50 POST OFFICE RD STE 303
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3704
Country	:	US
Telephone Number	:	240-349-2448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	08/22/2023

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