Provider Demographics
NPI:1275227118
Name:STEWART, AMANDA CAROL (DNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROL
Last Name:STEWART
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 BALDWIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1907
Mailing Address - Country:US
Mailing Address - Phone:443-752-9850
Mailing Address - Fax:
Practice Address - Street 1:9376 ATLEE STATION RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2602
Practice Address - Country:US
Practice Address - Phone:804-730-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222428363LF0000X
VA0024187683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily