Healthcare Provider Details

I. General information

NPI: 1215481858
Provider Name (Legal Business Name): AMANDA MARIE HILL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA MARIE ECTOR

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 OLD WASHINGTON RD SUITE 100
WALDORF MD
20602-3233
US

IV. Provider business mailing address

3510 OLD WASHINGTON RD SUITE 100
WALDORF MD
20602-3233
US

V. Phone/Fax

Practice location:
  • Phone: 301-932-5890
  • Fax: 301-645-6361
Mailing address:
  • Phone: 301-932-5890
  • Fax: 301-645-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR185549
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: