1942442926 NPI number — SHEILA WALLER CRNP

Table of content: SHEILA WALLER CRNP (NPI 1942442926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942442926 NPI number — SHEILA WALLER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLER
Provider First Name:
SHEILA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAPPLE
Provider Other First Name:
SHEILA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942442926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 UPPER CHESAPEAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-879-9100
Provider Business Mailing Address Fax Number:
410-638-0408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9114 PHILADELPHIA RD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-248-6300
Provider Business Practice Location Address Fax Number:
410-686-4973
Provider Enumeration Date:
04/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R175178 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R175178 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)