Healthcare Provider Details

I. General information

NPI: 1306180880
Provider Name (Legal Business Name): AMANDA PAIGE MUNRO RN, MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISONCON AVE
BETHESDA MD
20889-2045
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 843-271-5241
  • Fax:
Mailing address:
  • Phone: 843-271-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR178958
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR178958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: