Provider Demographics
NPI:1992138598
Name:SHYTLE, MARY KRISTEN (CRNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KRISTEN
Last Name:SHYTLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KRISTEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:10110 MOLECULAR DRIVE
Mailing Address - Street 2:SUITE #206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-238-8988
Practice Address - Street 1:10110 MOLECULAR DRIVE
Practice Address - Street 2:SUITE #206
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:240-403-0190
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207510363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health