Provider Demographics
NPI:1962021766
Name:SHIM, ALISHA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:SHIM
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 1:5722 HILDEBRAND RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6843
Mailing Address - Country:US
Mailing Address - Phone:301-660-8529
Mailing Address - Fax:269-248-8420
Practice Address - Street 1:5722 HILDEBRAND RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-6843
Practice Address - Country:US
Practice Address - Phone:301-660-8529
Practice Address - Fax:269-284-8420
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205285363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner