Provider Demographics
NPI:1003586991
Name:RICKEY-SHAREK, NINA (CRNP)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:RICKEY-SHAREK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 MCCORMICK RD STE 350
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8618
Mailing Address - Country:US
Mailing Address - Phone:443-849-6257
Mailing Address - Fax:
Practice Address - Street 1:1902 WALTMAN RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2338
Practice Address - Country:US
Practice Address - Phone:443-643-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily