Individual
GWENDOLYN GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN-BC, CRRN, CCM
Contact information
Practice address
16030 CARNATION DR, PUNTA GORDA, FL 33955-7156
(843) 813-4100
Mailing address
2111 WILSON RUN RD, WALLINGFORD, KY 41093-8955
(843) 813-4410
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
2833022
FL
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
10/18/2023
Last updated
10/18/2023
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