Provider Demographics
NPI:1235335829
Name:BAULER, AMANDA BROOKE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:BAULER
Suffix:
Gender:F
Credentials:FNP-BC
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 122
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-0122
Mailing Address - Country:US
Mailing Address - Phone:240-738-0954
Mailing Address - Fax:301-238-7386
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1416
Practice Address - Country:US
Practice Address - Phone:240-738-0953
Practice Address - Fax:301-238-7386
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV97594363LF0000X
MDR229244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500633129Medicaid
WAG8962288Medicare PIN
WAG8953006Medicare PIN