Provider Demographics
NPI:1932437142
Name:YORKMAN, SHANNON RENEE SEGRES
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE SEGRES
Last Name:YORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 HORSEMAN CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4065
Mailing Address - Country:US
Mailing Address - Phone:443-392-7572
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-4965
Practice Address - Country:US
Practice Address - Phone:410-955-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-28
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161384367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD030261900Medicaid
MD178505ZAR5Medicare PIN