Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R192204 | MD |
NPI | 1023312485 |
---|---|
Provider Name | Ms. Sherri L Mongeon |
First Address | Baltimore, MD 21224-5238 |
Second Address | Baltimore, MD 21224-5238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2010 |
Last Update Date | 30/06/2011 |