| NPI | 1083022966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL V SHANNON Executive Director 410-299-3803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R121021) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R121021) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |