Provider Demographics
NPI:1619418712
Name:ALBEROTANZA, AMANDA WOODWELL (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WOODWELL
Last Name:ALBEROTANZA
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JEANNE
Other - Last Name:WOODWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, CPNP
Mailing Address - Street 1:809 BLACK CHERRY WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2531
Mailing Address - Country:US
Mailing Address - Phone:808-397-0837
Mailing Address - Fax:
Practice Address - Street 1:200 FORBES ST STE 200
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-263-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics