Individual
MRS. MARY ALICE S SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1380 PROGRESS WAY, SUITE 114, ELDERSBURG, MD 21784-6464
(410) 795-2233
(410) 795-3538
Mailing address
1380 PROGRESS WAY, SUITE 114, ELDERSBURG, MD 21784-6464
(410) 795-2233
(410) 795-3538
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R124642
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124L
MEDICARE GROUP #-CARROLL PRIMARY CARE-124L
MD
01
—
R124642
STATE OF MD
MD
Enumeration date
10/20/2005
Last updated
05/17/2010
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