Provider Demographics
NPI:1902550197
Name:CRIDER, SHARITA REGINA (CRNP-FAMILY)
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:REGINA
Last Name:CRIDER
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3407
Mailing Address - Country:US
Mailing Address - Phone:410-683-6517
Mailing Address - Fax:
Practice Address - Street 1:9901 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3407
Practice Address - Country:US
Practice Address - Phone:410-683-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty