Healthcare Provider Details

I. General information

NPI: 1104032010
Provider Name (Legal Business Name): CATHERINE S SACKETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 NATHAN SHOCK DR GRC HANDLS
BALTIMORE MD
21224-6825
US

IV. Provider business mailing address

11420 MANOR RD
GLEN ARM MD
21057-9412
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-8015
  • Fax: 410-558-8019
Mailing address:
  • Phone: 410-882-9845
  • Fax: 410-663-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR051350
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: