1962793729 NPI number — MISS NATHALIE MIRIAM SHELOR CPNP

Table of content: MISS NATHALIE MIRIAM SHELOR CPNP (NPI 1962793729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962793729 NPI number — MISS NATHALIE MIRIAM SHELOR CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELOR
Provider First Name:
NATHALIE
Provider Middle Name:
MIRIAM
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962793729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6830 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE #206
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-238-5390
Provider Business Mailing Address Fax Number:
410-238-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6830 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-238-5390
Provider Business Practice Location Address Fax Number:
410-238-5396
Provider Enumeration Date:
04/28/2011

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: 363LP0200X , with the licence number:  R194676 , 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)





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