Provider Demographics
NPI:1780380741
Name:SHENK, DIANA MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MICHELLE
Last Name:SHENK
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 1:815 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1242
Mailing Address - Country:US
Mailing Address - Phone:443-710-5125
Mailing Address - Fax:
Practice Address - Street 1:227 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4287
Practice Address - Country:US
Practice Address - Phone:410-638-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203048363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care