Individual
JENNIFER S GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
C0002836
MD
363AS0400X
Surgical Physician Assistant
Primary
C0002836
MD
Other
Enumeration date
05/03/2006
Last updated
01/24/2020
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