Shirley Jane Sample, C.R.N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R080367 Issued in MD

Practice address

1300 Bellona Ave Ste B
Lutherville, MD 21093-5466

Phone

(844) 606-5105

NPI assigned

Dec 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1417019936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 HANNIBAL RD",
            "city": "GLEN ARM",
            "state": "MD",
            "postal_code": "210579207",
            "telephone_number": "443-807-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BELLONA AVE STE B",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210935466",
            "telephone_number": "844-606-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "SHIRLEY",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R080367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Safe Harbor Christian Counseling
• Saltsman and Associates
• Robert Hancock Wood Saltsman Jr., M.S.
• Corey Samek, COTA/L
• Samirabetulallc
• Imani Sanchez
• Karla Yolanda Sanchez, M.D.
• Sandra S. Rosenblatt, PH.D., P.a.
• Naarah Atarah Sandy, M.S., CFY-SLP
• Satellite Anesthesia LLC

• Adult Health Nurse Practitioner in Lutherville, MD
• Providers in Lutherville, MD by specialty
• Adult Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.