Provider Demographics
NPI:1639178593
Name:SEASHOLE, MARILYN J (CRNP-A)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:J
Last Name:SEASHOLE
Suffix:
Gender:F
Credentials:CRNP-A
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:DELOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP-A
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-881-7246
Mailing Address - Fax:301-881-2449
Practice Address - Street 1:11921 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 505
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2737
Practice Address - Country:US
Practice Address - Phone:301-881-7246
Practice Address - Fax:301-881-2449
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072858363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP36876Medicare UPIN