Healthcare Provider Details

I. General information

NPI: 1881315364
Provider Name (Legal Business Name): AMANDA REISS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA REISS

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN
COLUMBIA MD
21044-2912
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7890
  • Fax:
Mailing address:
  • Phone: 410-933-0000
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1063468
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAC007676
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: