Organization
AUTHENTIC RELEASE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON MARTIN CRNP (OWNER)
(301) 804-0344
Entity
Organization
Contact information
Practice address
1406B CRAIN HWY S STE 306, GLEN BURNIE, MD 21061-4094
(301) 804-0344
(301) 349-1370
Mailing address
1406B CRAIN HWY S STE 306, GLEN BURNIE, MD 21061-4094
(301) 804-0344
(301) 349-1370
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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