Individual
DIAN GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7000
Mailing address
1953 HIGHWAY 11 W, BRISTOL, TN 37620-8543
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN54210
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3605025
—
TN
Enumeration date
05/09/2006
Last updated
01/15/2008
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