Provider Demographics
NPI:1396783320
Name:GLEITSMANN, MICHELE ELCANO (MS, APRN, BC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELCANO
Last Name:GLEITSMANN
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:JANE
Other - Last Name:ELCANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, APRN, BC
Mailing Address - Street 1:PO BOX 630973
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-0973
Mailing Address - Country:US
Mailing Address - Phone:410-286-0664
Mailing Address - Fax:410-286-0664
Practice Address - Street 1:2021 CHANEYVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-4319
Practice Address - Country:US
Practice Address - Phone:410-286-0664
Practice Address - Fax:410-286-0664
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR057725163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377MK503Medicare PIN