MEDICARE: CARLENE GAYLE BANKS

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	374U00000X	Home Health Aide	R4367	MD

General Provider Information

NPI Number	:	1760086060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLENE GAYLE BANKS

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-0428
Country	:	US
Telephone Number	:	301-679-9653
Fax Number	:	240-493-2603

Provider Business Practice Location Address
First Line	:	6475 NEW HAMPSHIRE AVE STE 604
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3280
Country	:	US
Telephone Number	:	240-481-7844
Fax Number	:	240-494-2603

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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