Individual
BEVERLY JO GANN
Active
Individual
BEVERLY JO GANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC,WHNP
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
RN 091078
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003802406
—
MO
05
—
425443736
—
MO
01
—
P00314636
RR MEDICARE
—
Enumeration date
09/21/2005
Last updated
06/16/2011
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