Provider Demographics
NPI:1942042122
Name:DUBOSE, SHENISE JAMES- (RN, DN)
Entity type:Individual
Prefix:MRS
First Name:SHENISE
Middle Name:JAMES-
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:RN, DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 ALLENDER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1307
Mailing Address - Country:US
Mailing Address - Phone:443-813-1208
Mailing Address - Fax:
Practice Address - Street 1:3310 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4108
Practice Address - Country:US
Practice Address - Phone:443-708-5056
Practice Address - Fax:667-400-6118
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR232062163WA0400X, 163WC0400X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management