Provider Demographics
NPI:1275545980
Name:SHADIS, ELIZABETH LAYNE (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAYNE
Last Name:SHADIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LAYNE
Other - Last Name:CONELIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1331 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4220
Mailing Address - Country:US
Mailing Address - Phone:443-996-7528
Mailing Address - Fax:410-837-1552
Practice Address - Street 1:1331 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4220
Practice Address - Country:US
Practice Address - Phone:443-996-7528
Practice Address - Fax:410-837-1552
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122580363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology