Healthcare Provider Details

I. General information

NPI: 1073392445
Provider Name (Legal Business Name): TAYANNA GUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

582 LUCIA AVE
BALTIMORE MD
21229-4514
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-9185
  • Fax:
Mailing address:
  • Phone: 443-629-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP55870
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: