Provider Demographics
NPI:1770240194
Name:GAITHER, JENNIFER LARA (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LARA
Last Name:GAITHER
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 1:4401 ROLAND AVE UNIT 502
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2796
Mailing Address - Country:US
Mailing Address - Phone:410-375-7933
Mailing Address - Fax:
Practice Address - Street 1:4401 ROLAND AVE UNIT 502
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2796
Practice Address - Country:US
Practice Address - Phone:410-375-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144822163W00000X
MDR144866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse