MEDICARE: JUDE V AMARA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	R1765165	MD
2	367500000X	Certified Registered Nurse Anesthetist	L6-0A10949	DE
3	367500000X	Certified Registered Nurse Anesthetist	137956	PA

General Provider Information

NPI Number	:	1295470706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDE V AMARA CRNA

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 HARDWOOD TER
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-9104
Country	:	US
Telephone Number	:	717-969-4658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	12/09/2024

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Directions to “ JUDE V AMARA CRNA” Practice Location

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