=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104032010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE S SACKETT CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 12/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 NATHAN SHOCK DR GRC HANDLS
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-6825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-558-8015
-----------------------------------------------------
Fax | 410-558-8019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11420 MANOR RD
-----------------------------------------------------
City | GLEN ARM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21057-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-882-9845
-----------------------------------------------------
Fax | 410-663-0451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | R051350
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------