Provider Demographics
NPI:1851486922
Name:GANT-LONDON, GLENDA (NP)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:
Last Name:GANT-LONDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 OAK HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5702
Mailing Address - Country:US
Mailing Address - Phone:985-726-9333
Mailing Address - Fax:
Practice Address - Street 1:1100 E JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5405
Practice Address - Country:US
Practice Address - Phone:504-333-6988
Practice Address - Fax:504-342-2184
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN063028363LF0000X
LAAP04915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily