Provider Demographics
NPI:1437685823
Name:BANNERMAN, RENEE (RN, BSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BANNERMAN
Suffix:
Gender:F
Credentials:RN, BSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N. CALVERT STREET
Mailing Address - Street 2:LL08
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:301-728-1473
Mailing Address - Fax:410-554-6534
Practice Address - Street 1:3333 N CALVERT ST STE LL8
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6520
Practice Address - Country:US
Practice Address - Phone:410-554-6550
Practice Address - Fax:410-554-6534
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1011913163W00000X
MDR190445163W00000X, 363L00000X
DCRN1011913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily