Healthcare Provider Details

I. General information

NPI: 1265912976
Provider Name (Legal Business Name): AMANDA FABIAN DNP, CRNA, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA HERNANDEZ

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

7601 OSLER DR
TOWSON MD
21204-7700
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-1000
  • Fax:
Mailing address:
  • Phone: 410-337-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR200689
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR200689
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR200689
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: