Provider Demographics
NPI:1972769420
Name:GANT, CHARIS RENEE
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:RENEE
Last Name:GANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARIS
Other - Middle Name:RENEE
Other - Last Name:GOLIGOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2070 MORNINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3662
Mailing Address - Country:US
Mailing Address - Phone:720-985-3071
Mailing Address - Fax:
Practice Address - Street 1:5257 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2228
Practice Address - Country:US
Practice Address - Phone:303-932-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45046164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse