Provider Demographics
NPI:1093581647
Name:GILLIARD, RENADA LYNN (DNP, MS, CRNP)
Entity Type:Individual
Prefix:DR
First Name:RENADA
Middle Name:LYNN
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:DNP, MS, CRNP
Other - Prefix:
Other - First Name:RENADA
Other - Middle Name:LYNN
Other - Last Name:BECKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9 TURK GARTH
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2806
Mailing Address - Country:US
Mailing Address - Phone:443-695-4433
Mailing Address - Fax:
Practice Address - Street 1:9 TURK GARTH
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2806
Practice Address - Country:US
Practice Address - Phone:443-695-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111793363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health