Healthcare Provider Details

I. General information

NPI: 1912020124
Provider Name (Legal Business Name): GENEVIEVE SADERHOLM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7031
US

IV. Provider business mailing address

2299 PATUXENT OVERLOOK RD
GAMBRILLS MD
21054-1943
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-7213
  • Fax: 410-222-7348
Mailing address:
  • Phone: 410-451-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR064201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: