| NPI | 1790453900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LATASHA SHELL Provider 410-800-6186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2026-07-17 |