Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 306629 | NY |
Y | 363LA2200X | Nurse Practitioner - Adult Health | R191607 | MD |
NPI | 1013335397 |
---|---|
Provider Name | Ms. Shanna Fortune |
First Address | Baltimore, MD 21201-1544 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 22/12/2020 |