Individual
AMANDA S WALTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-8639
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-8639
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R176495
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419790900
—
MD
01
—
962462-01 & 02
BLUE CROSS/BLUE SHIELD
MD
01
—
S062-0383
BLUE CROSS/BLUE SHIELD - REGIONAL
MD
Enumeration date
02/02/2010
Last updated
02/01/2013
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