Individual
SHANNON ACQUAVIVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9733 HARVESTER CIR, PERRY HALL, MD 21128-9027
(443) 415-3167
Mailing address
9733 HARVESTER CIR, PERRY HALL, MD 21128-9027
(443) 725-4763
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R178155
MD
Other
Enumeration date
12/28/2017
Last updated
12/28/2017
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