Healthcare Provider Details

I. General information

NPI: 1144372541
Provider Name (Legal Business Name): AMANDA M BAILEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 THOMAS JOHNSON DR
FREDERICK MD
21702-4384
US

IV. Provider business mailing address

610 SOLAREX COURT
FREDERICK MD
21703
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-7600
  • Fax: 301-228-2500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR131979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: