Provider Demographics
NPI:1043602949
Name:WROE, AMONDA BENTLEY (NP)
Entity Type:Individual
Prefix:MS
First Name:AMONDA
Middle Name:BENTLEY
Last Name:WROE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:317 CENTRAL AVE
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21071
Mailing Address - Country:US
Mailing Address - Phone:443-797-9241
Mailing Address - Fax:
Practice Address - Street 1:317 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21071-4216
Practice Address - Country:US
Practice Address - Phone:443-797-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119539363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology