Provider Demographics
NPI:1407326119
Name:GANN, ANTHONY J (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:GANN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3461
Mailing Address - Country:US
Mailing Address - Phone:714-657-0687
Mailing Address - Fax:
Practice Address - Street 1:173 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3461
Practice Address - Country:US
Practice Address - Phone:714-657-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95091739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3382459OtherCALIFORNIA DRIVERS LICENSE