Individual
TAMMY L GANNAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
37 PARK ST, LEWISTON, ME 04240-7195
(207) 333-1080
(207) 777-4649
Mailing address
PO BOX 2621, WATERVILLE, ME 04903-2621
(207) 272-0638
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN001615
NV
363LF0000X
Family Nurse Practitioner
Primary
CNP91069
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1475901
MEDICARE B
ME
05
—
435223099
—
ME
01
—
APRN001615
NV APRN
NV
01
—
CNP91069
ME APRN
ME
Enumeration date
12/16/2009
Last updated
01/10/2023
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