Individual
SHANNON D CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
372 MAIN STREET, LAUREL, MD 20707
(240) 294-4079
Mailing address
3019 BRODKIN AVE, FORT WASHINGTON, MD 20744-2306
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R217859
MD
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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