Doctor Name: | MRS. LEAH VARDEN GANN |
NPI Number: | 1780930826 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-121708 |
Business Practice Address: | 143 White Oak Trl Warrior, AL - 351805736 |
Business Phone Number: | 2056471819 |
Business Fax Number: | |
Mailing Address: | 143 White Oak Trl, WARRIOR |
State: | AL |
Postal Code: | 351805736 |
Phone Number: | 2056471819 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2012 |
NPI Last Update Date: | 07/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-121708 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |