Individual
JAMIE GANLEY
Active
Individual
JAMIE GANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
LJ-0000310
DE
363L00000X
Nurse Practitioner
L1-0041332
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0539457
—
NJ
05
—
1136569-00
—
MD
Enumeration date
12/28/2013
Last updated
04/25/2017
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