Healthcare Provider Details

I. General information

NPI: 1275736167
Provider Name (Legal Business Name): JANELL S GILLIAM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

2716 OAKLEY AVE
BALTIMORE MD
21215-5311
US

V. Phone/Fax

Practice location:
  • Phone: 410-770-1313
  • Fax:
Mailing address:
  • Phone: 443-813-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025062243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: