MEDICARE: LAURIE SCUDDER MS, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	R073557	MD

General Provider Information

NPI Number	:	1144341009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE SCUDDER MS, NP

Provider Business Mailing Address
First Line	:	9556 WANDERING WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3244
Country	:	US
Telephone Number	:	410-992-7129
Fax Number	:	410-992-7216

Provider Business Practice Location Address
First Line	:	2000 EDGEWOOD ST
Second Line	:	WALBROOK HIGH SCHOOL BASED HEALTH CENTER
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2537
Country	:	US
Telephone Number	:	410-396-0737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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