Healthcare Provider Details

I. General information

NPI: 1679220107
Provider Name (Legal Business Name): AMANDA TAYLOR PEYRONEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LEE TAYLOR

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19820 CENTURY BLVD
GERMANTOWN MD
20874-1198
US

IV. Provider business mailing address

19820 CENTURY BLVD
GERMANTOWN MD
20874-1198
US

V. Phone/Fax

Practice location:
  • Phone: 301-528-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR240371
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR240371
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: