Healthcare Provider Details

I. General information

NPI: 1235335829
Provider Name (Legal Business Name): AMANDA BROOKE BAULER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAIN ST
HANCOCK MD
21750-1416
US

IV. Provider business mailing address

PO BOX 122
HANCOCK MD
21750-0122
US

V. Phone/Fax

Practice location:
  • Phone: 240-738-0953
  • Fax: 301-238-7386
Mailing address:
  • Phone: 240-738-0954
  • Fax: 301-238-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR229244
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number97594
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR229244
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number97594
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: