Individual
SHANNON K IDZIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
655 W LOMBARD ST, 345, BALTIMORE, MD 21201-1512
(410) 706-8129
(410) 706-0344
Mailing address
655 W LOMBARD ST, 345, BALTIMORE, MD 21201-1512
(410) 706-8129
(410) 706-0344
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
R131534
MD
Other
Enumeration date
08/30/2005
Last updated
01/10/2011
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