Provider Demographics
NPI:1619723335
Name:CARMEN, AMANDA ROSE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROSE
Last Name:CARMEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24430 STONE SPRINGS BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2272
Mailing Address - Country:US
Mailing Address - Phone:703-957-1245
Mailing Address - Fax:703-665-2374
Practice Address - Street 1:24430 STONE SPRINGS BLVD STE 475
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2272
Practice Address - Country:US
Practice Address - Phone:703-957-1245
Practice Address - Fax:703-665-2374
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024189493367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife