Individual
MRS. AMANDA BRADY WATTERS GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, RN
Contact information
Practice address
8 HATTERS LN, FARMINGTON, CT 06032-2332
(917) 567-5260
(844) 364-2618
Mailing address
2113 HIGHLAND RIDGE DR, PHOENIX, MD 21131-1217
(917) 567-5260
(844) 364-2618
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R214487
MD
174N00000X
Lactation Consultant (Non-RN)
Primary
—
MD
363LP0200X
Pediatric Nurse Practitioner
R214487
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092172600
—
MD
Enumeration date
08/31/2011
Last updated
01/25/2022
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