MEDICARE: MS. MARY HEALY SHINER R.N., M.S., C.P.N.P.

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	363LP0200X	Pediatric Nurse Practitioner	R053821	MD

General Provider Information

NPI Number	:	1326246661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY HEALY SHINER R.N., M.S., C.P.N.P.

Provider Business Mailing Address
First Line	:	1021 COLD SPRING RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21220-4425
Country	:	US
Telephone Number	:	410-335-2607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 TWIN SPRINGS RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-3526
Country	:	US
Telephone Number	:	410-887-4456
Fax Number	:	410-887-4456

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

Provider Enumeration Date	:	07/09/2007
Last Update Date	:	07/09/2007

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