Healthcare Provider Details

I. General information

NPI: 1477586287
Provider Name (Legal Business Name): CHRISTINA L SHUJA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE LORETE FNP

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MORTON MOWER, M.D., OFF. BLDG. 2411 W. BELVEDERE AVENUE, SUITE 407
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 W BELVEDERE AVE ATTN: CREDENTIALING
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8663
  • Fax: 410-601-5389
Mailing address:
  • Phone: 410-601-5524
  • Fax: 410-601-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR153803
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: