Healthcare Provider Details

I. General information

NPI: 1770791261
Provider Name (Legal Business Name): SHERRY LYNN DISHAROON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 YORK RD
BALTIMORE MD
21212-2152
US

IV. Provider business mailing address

6401 YORK ROAD
BALTIMORE MD
21212
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-2705
  • Fax:
Mailing address:
  • Phone: 410-661-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR122102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: