Provider Demographics
NPI:1033696778
Name:GANTZ, KARRAH MICHI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KARRAH
Middle Name:MICHI
Last Name:GANTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2348
Mailing Address - Country:US
Mailing Address - Phone:203-767-0721
Mailing Address - Fax:
Practice Address - Street 1:400 WHITE SPRUCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1619
Practice Address - Country:US
Practice Address - Phone:585-424-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily