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General NPI Number Information
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NPI Number | 1295788958
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Entity Type | Individual
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Provider Name | SHAWNA SPEARS MUDD DNP, CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 1132 ANNAPOLIS RD STE 201
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City | ODENTON
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State | MD
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Zip | 21113-1673
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Country | US
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Telephone | 410-874-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 9910 FRANKLIN SQUARE DR # 2110
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City | BALTIMORE
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State | MD
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Zip | 21236-4902
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Country | US
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Telephone | 410-933-5412
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Fax | 410-933-1390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R119369
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License Number State | MD
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