Individual
LAANITA GILLISPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(301) 609-4285
(301) 934-6958
Mailing address
196 THOMAS JOHNSON DR STE 215, FREDERICK, MD 21702-4527
(301) 668-9988
(240) 782-1013
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
149605
TN
163W00000X
Registered Nurse
180952
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
AC002237
MD
Other
Enumeration date
01/15/2018
Last updated
08/26/2019
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