Provider Demographics
NPI:1629592845
Name:CRUSH, SHANNON (CD(DONA))
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CRUSH
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4818
Mailing Address - Country:US
Mailing Address - Phone:443-624-8383
Mailing Address - Fax:
Practice Address - Street 1:668 SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657
Practice Address - Country:US
Practice Address - Phone:443-342-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula