Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R119539 | MD |
N | 363LA2200X | Nurse Practitioner - Adult Health | R119539 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R119539 | MD |
NPI | 1043602949 |
---|---|
Provider Name | Ms. Amonda Bentley Wroe |
First Address | Glyndon, MD 21071 |
Second Address | Glyndon, MD 21071-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2015 |
Last Update Date | 22/09/2016 |