Organization
SEVA HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGEL V SHANNON CRNP (EXECUTIVE DIRECTOR)
(410) 299-3803
Entity
Organization
Contact information
Practice address
9133 SUNSET RIDGE RD, RANDALLSTOWN, MD 21133-3651
(410) 299-3803
Mailing address
9133 SUNSET RIDGE RD, RANDALLSTOWN, MD 21133-3651
(410) 299-3803
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R121021
MD
363LG0600X
Gerontology Nurse Practitioner
R121021
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065284900
—
MD
Enumeration date
07/23/2014
Last updated
07/23/2014
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