Provider Demographics
NPI:1437195062
Name:GEMMELL, EILEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:GEMMELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:301-572-8340
Mailing Address - Fax:301-572-8403
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-572-8340
Practice Address - Fax:301-572-8403
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158667363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62119701OtherBCBS OF MD
0036OtherCAREFIRST
52-2096682OtherTRICARE NORTH
8301559OtherEVERCARE
MD403206300Medicaid
262573538002OtherTRICARE - EMPLOYEE HEALTH
52-2096682OtherTRICARE NORTH
MD62119701OtherBCBS OF MD
262573538002OtherTRICARE - EMPLOYEE HEALTH