Provider Demographics
NPI:1184771966
Name:SEWARD, SHIRLEY JO (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JO
Last Name:SEWARD
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 1:24150 CARRLYN DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6085 MARSHALEE DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6023
Practice Address - Country:US
Practice Address - Phone:410-379-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS135F295Medicare ID - Type Unspecified
MDS82813Medicare UPIN