Individual
CARL GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12800 BOTHELL EVERETT HWY, EVERETT, WA 98208-6642
(425) 316-5180
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
22398
CA
363LF0000X
Family Nurse Practitioner
22998
CA
363LF0000X
Family Nurse Practitioner
Primary
AP60628896
WA
Other
Enumeration date
08/06/2012
Last updated
05/20/2021
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