Individual
MS. SHIRLEY JANE SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
1300 BELLONA AVE STE B, LUTHERVILLE, MD 21093-5466
(844) 606-5105
Mailing address
11525 HANNIBAL RD, GLEN ARM, MD 21057-9207
(443) 807-1737
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R080367
MD
Other
Enumeration date
12/14/2006
Last updated
08/20/2014
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