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Individual
LISA D GANTT
Active
Individual
LISA D GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A764
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1874
MEDICARE PTAN
SC
01
—
P01251001
RAILROAD MEDICARE
SC
05
—
PA1845
—
SC
Enumeration date
11/15/2005
Last updated
01/31/2014
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