Provider Demographics
NPI:1760086060
Name:GAYLE BANKS, CARLENE
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:GAYLE BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-0428
Mailing Address - Country:US
Mailing Address - Phone:301-679-9653
Mailing Address - Fax:240-493-2603
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 604
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3280
Practice Address - Country:US
Practice Address - Phone:240-481-7844
Practice Address - Fax:240-494-2603
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4367374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide