MEDICARE: MRS. GENEVIEVE SADERHOLM R.N.

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	163WA2000X	Administrator Registered Nurse	R064201	MD

General Provider Information

NPI Number	:	1912020124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GENEVIEVE SADERHOLM R.N.

Provider Business Mailing Address
First Line	:	2299 PATUXENT OVERLOOK RD
Second Line	:
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1943
Country	:	US
Telephone Number	:	410-451-4713
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HARRY S TRUMAN PKWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7031
Country	:	US
Telephone Number	:	410-222-7213
Fax Number	:	410-222-7348

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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