Healthcare Provider Details

I. General information

NPI: 1235416835
Provider Name (Legal Business Name): SHANON PLESHETTE SNEAD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W MOUNT ROYAL AVE
BALTIMORE MD
21217-4289
US

IV. Provider business mailing address

2015 SPRING RD STE 300
OAK BROOK IL
60523-3944
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-1325
  • Fax:
Mailing address:
  • Phone: 630-725-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberR157353
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: