Individual
ANNA GANAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6625 S LANTANA VISTA DR, TUCSON, AZ 85756-8675
(520) 721-1887
(520) 344-8892
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 344-8892
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN189398
AZ
164W00000X
Licensed Practical Nurse
LP046337
AZ
171W00000X
Contractor
BH5661
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
635634
—
AZ
01
—
BH5661
BRFL LICENSE (BEHAVIORAL HEALTH THERAPEUTIC HOME)
AZ
Enumeration date
06/20/2011
Last updated
01/08/2021
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