# MRS. MARY ALICE S SHORES

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1922097161
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R124642 | MD | Yes |

## Other

- **Enumeration date:** 10/20/2005
- **Last updated:** 05/17/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 124L | MEDICARE GROUP \#-CARROLL PRIMARY CARE-124L | MD |
| 01 | — | R124642 | STATE OF MD | MD |