Provider Demographics
NPI:1235386939
Name:GANTT, JENDAYI (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JENDAYI
Middle Name:
Last Name:GANTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NEW CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5821
Mailing Address - Country:US
Mailing Address - Phone:302-655-6187
Mailing Address - Fax:
Practice Address - Street 1:601 NEW CASTLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5821
Practice Address - Country:US
Practice Address - Phone:302-655-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK-0000153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR163670OtherSTATE LICENSE
DELK-0000153OtherSTATE LICENSE