Individual
DR. JENDAYI GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, CNM, PMHNP-BC
Contact information
Practice address
4690 MILLENNIUM DR STE 300, BELCAMP, MD 21017-1527
(443) 255-6499
Mailing address
4690 MILLENNIUM DR STE 300, BELCAMP, MD 21017-1527
(443) 255-6499
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R163670
MD
367A00000X
Advanced Practice Midwife
R163670
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R163670
STATE LICENSE
MD
Enumeration date
08/25/2008
Last updated
08/05/2024
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