Provider Demographics
NPI:1942442926
Name:WALLER, SHEILA (CRNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:D
Other - Last Name:CHAPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-638-0408
Practice Address - Street 1:9114 PHILADELPHIA RD STE 108
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4346
Practice Address - Country:US
Practice Address - Phone:410-248-6300
Practice Address - Fax:410-686-4973
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175178363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty