Healthcare Provider Details

I. General information

NPI: 1477974764
Provider Name (Legal Business Name): SHANNON HOLDER DNP, NP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7596 RITCHIE HWY UNIT 2037
GLEN BURNIE MD
21060-8883
US

IV. Provider business mailing address

7596 RITCHIE HWY UNIT 2037
GLEN BURNIE MD
21060-8883
US

V. Phone/Fax

Practice location:
  • Phone: 410-982-6682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR170448
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR170448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: