MEDICARE: SHANNON MARISSA LARMOOH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R159668	MD

General Provider Information

NPI Number	:	1306312541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARISSA LARMOOH FNP

Provider Business Mailing Address
First Line	:	6225 SMITH AVE STE B300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3613
Country	:	US
Telephone Number	:	667-208-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 SMITH AVE STE B300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3613
Country	:	US
Telephone Number	:	667-208-8855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	12/23/2025

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