Individual
THERESA ANN GANOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
8700 SUDLEY RD, MANASSAS, VA 20110
(703) 396-5292
(703) 396-5297
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(703) 396-5292
(703) 396-5297
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0024171161
VA
363L00000X
Nurse Practitioner
Primary
0024171161
VA
363LA2100X
Acute Care Nurse Practitioner
RN1005293
DC
Other
Enumeration date
10/18/2012
Last updated
08/22/2018
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