Healthcare Provider Details

I. General information

NPI: 1306626619
Provider Name (Legal Business Name): AMANDA WERNER MISSET DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA BETH WERNER

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64442
BALTIMORE MD
21264-4442
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-7877
  • Fax: 410-328-1048
Mailing address:
  • Phone: 410-328-8040
  • Fax: 410-328-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR220237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: