Provider Demographics
NPI:1265912976
Name:FABIAN, AMANDA (MS, RN, CCRN, SRNA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MS, RN, CCRN, SRNA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:655 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY STE 800
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3569
Practice Address - Country:US
Practice Address - Phone:410-591-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN693077163WG0000X
DCRN500011760163WG0000X
MDR200689163WG0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse