Provider Demographics
NPI:1356804561
Name:GANGWISCH, CHRISTINE (MSN, APRN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GANGWISCH
Suffix:
Gender:F
Credentials:MSN, APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8029
Mailing Address - Country:US
Mailing Address - Phone:770-921-9420
Mailing Address - Fax:770-921-9421
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-721-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240343163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse