Individual
AMY GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 MIDDLEBRIDGE RD, WAKEFIELD, RI 02879-7105
(860) 817-6905
Mailing address
201 MIDDLEBRIDGE RD, WAKEFIELD, RI 02879-7105
(860) 817-6905
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/31/2017
Last updated
01/31/2017
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