Healthcare Provider Details

I. General information

NPI: 1861120008
Provider Name (Legal Business Name): SHANNON ARTIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
BALTIMORE MD
21204-6808
US

IV. Provider business mailing address

6701 N CHARLES ST
BALTIMORE MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2000
  • Fax:
Mailing address:
  • Phone: 443-849-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR211275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: