Healthcare Provider Details

I. General information

NPI: 1124945449
Provider Name (Legal Business Name): NICOLE SHAWNTEL HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 DEWDROP WAY
CLINTON MD
20735-5804
US

IV. Provider business mailing address

7004 DEWDROP WAY
CLINTON MD
20735-5804
US

V. Phone/Fax

Practice location:
  • Phone: 301-346-5151
  • Fax:
Mailing address:
  • Phone: 301-346-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: