Provider Demographics
NPI:1275791675
Name:GANNON, JANET LEE (LMP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:GANNON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LEE
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:12121 E BROADWAY
Mailing Address - Street 2:BLDG 5B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-921-9800
Mailing Address - Fax:509-921-9810
Practice Address - Street 1:12121 E BROADWAY
Practice Address - Street 2:BLDG 5B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-921-9800
Practice Address - Fax:509-921-9810
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist