Healthcare Provider Details

I. General information

NPI: 1891912192
Provider Name (Legal Business Name): SHARON SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N CHARLES ST
BALTIMORE MD
21218-2608
US

IV. Provider business mailing address

2741 SAM HILL RD
GLENVILLE PA
17329-9277
US

V. Phone/Fax

Practice location:
  • Phone: 410-516-8270
  • Fax: 410-516-4784
Mailing address:
  • Phone: 717-633-9808
  • Fax: 410-516-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR090330
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: