Healthcare Provider Details

I. General information

NPI: 1285556795
Provider Name (Legal Business Name): GWYNNETH L JARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CRAIN HWY S STE 502
GLEN BURNIE MD
21061-6441
US

IV. Provider business mailing address

390 SOUTH DR
SEVERNA PARK MD
21146-2111
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-8911
  • Fax:
Mailing address:
  • Phone: 410-562-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR185093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: