Provider Demographics
NPI:1659753903
Name:WOOD, AMANDA REGINA (CPNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REGINA
Last Name:WOOD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:REGINA
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N WOLFE ST
Mailing Address - Street 2:SUITE 2158
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0011
Mailing Address - Country:US
Mailing Address - Phone:410-955-4259
Mailing Address - Fax:410-614-2297
Practice Address - Street 1:200 N WOLFE ST
Practice Address - Street 2:SUITE 2158
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0011
Practice Address - Country:US
Practice Address - Phone:410-955-4259
Practice Address - Fax:410-614-2297
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181947363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics