Individual
GANNAT MOUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4926 W BROAD ST, RICHMOND, VA 23230-3122
(844) 624-7513
Mailing address
4926 W BROAD ST, RICHMOND, VA 23230-3122
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002107085
VA
Other
Enumeration date
12/19/2025
Last updated
12/19/2025
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