Healthcare Provider Details

I. General information

NPI: 1578335709
Provider Name (Legal Business Name): AMANDA JOY BERGER PMNHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9256 BENDIX RD STE 200B
COLUMBIA MD
21045-1848
US

IV. Provider business mailing address

1939 BAROLO BLVD
HANOVER MD
21076-2509
US

V. Phone/Fax

Practice location:
  • Phone: 443-542-0773
  • Fax: 443-542-0931
Mailing address:
  • Phone: 732-887-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR174967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: