Provider Demographics
NPI:1568688851
Name:GANGWER, CHARLOTTE I (RN, NP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:I
Last Name:GANGWER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9641 KIRK ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-4781
Mailing Address - Country:US
Mailing Address - Phone:317-898-4601
Mailing Address - Fax:317-536-6559
Practice Address - Street 1:7968 PENDLETON PIKE
Practice Address - Street 2:STE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-3957
Practice Address - Country:US
Practice Address - Phone:317-541-8101
Practice Address - Fax:317-536-6559
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN7100118A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health