Provider Demographics
NPI:1083153787
Name:GHANNAM, ALANTE Q (FNP)
Entity Type:Individual
Prefix:
First Name:ALANTE
Middle Name:Q
Last Name:GHANNAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALANTE
Other - Middle Name:QUANAI
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-645-3743
Mailing Address - Fax:314-647-7967
Practice Address - Street 1:1027 BELLEVUE AVE
Practice Address - Street 2:STE 107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1851
Practice Address - Country:US
Practice Address - Phone:314-645-3743
Practice Address - Fax:314-647-7967
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily