MEDICARE: JO GLENNA GAERLAN BANANIA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R176865	MD

General Provider Information

NPI Number	:	1154178903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO GLENNA GAERLAN BANANIA RN

Provider Business Mailing Address
First Line	:	24514 HANSON RD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20882-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 ROBERT GRANT AVENUE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-0000
Country	:	US
Telephone Number	:	301-319-7581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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