MEDICARE: MICHELE ELCANO GLEITSMANN M.S., A.P.R.N., B.C.

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	R057725	MD

General Provider Information

NPI Number	:	1396783320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ELCANO GLEITSMANN M.S., A.P.R.N., B.C.

Provider Business Mailing Address
First Line	:	PO BOX 630973
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21263-0973
Country	:	US
Telephone Number	:	410-286-0664
Fax Number	:	410-286-0664

Provider Business Practice Location Address
First Line	:	2021 CHANEYVILLE RD
Second Line	:	SUITE 102
City	:	OWINGS
State	:	MD
Zip	:	20736-4319
Country	:	US
Telephone Number	:	410-286-0664
Fax Number	:	410-286-0664

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/06/2007

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