Provider Demographics
NPI:1164752945
Name:URBAN, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:URBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ROCKVILLE PIKE
Mailing Address - Street 2:BUILDING 10, ROOM 9N228
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1203
Mailing Address - Country:US
Mailing Address - Phone:301-451-3191
Mailing Address - Fax:
Practice Address - Street 1:9000 ROCKVILLE PIKE
Practice Address - Street 2:BUILDING 10, ROOM 3-3330
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1203
Practice Address - Country:US
Practice Address - Phone:301-827-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily