Provider Demographics
NPI:1144341009
Name:SCUDDER, LAURIE (MS, NP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9556 WANDERING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3244
Mailing Address - Country:US
Mailing Address - Phone:410-992-7129
Mailing Address - Fax:410-992-7216
Practice Address - Street 1:2000 EDGEWOOD ST
Practice Address - Street 2:WALBROOK HIGH SCHOOL BASED HEALTH CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2537
Practice Address - Country:US
Practice Address - Phone:410-396-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073557363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics