Healthcare Provider Details

I. General information

NPI: 1114396637
Provider Name (Legal Business Name): CAROLINE SHIRIMA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAYO RD STE 201
EDGEWATER MD
21037-1442
US

IV. Provider business mailing address

20 MAYO RD STE 201
EDGEWATER MD
21037-1442
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-6800
  • Fax:
Mailing address:
  • Phone: 410-956-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR158677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: