MEDICARE: MEAGAN DENISE SHIPLEY C.R.N.P.

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	363LF0000X	Family Nurse Practitioner	R180604	MD

General Provider Information

NPI Number	:	1356580096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN DENISE SHIPLEY C.R.N.P.

Provider Business Mailing Address
First Line	:	1374 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-3536
Country	:	US
Telephone Number	:	410-396-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1374 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-3536
Country	:	US
Telephone Number	:	410-396-0353
Fax Number	:

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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Directions to “ MEAGAN DENISE SHIPLEY C.R.N.P.” Practice Location

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