Provider Demographics
NPI:1306026349
Name:GUMMER, JOAN ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELLEN
Last Name:GUMMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 YORK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2130
Mailing Address - Country:US
Mailing Address - Phone:410-887-2725
Mailing Address - Fax:
Practice Address - Street 1:6401 YORK RD STE 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2130
Practice Address - Country:US
Practice Address - Phone:410-887-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR044822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse