Individual
JEREMY GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 388-5432
Mailing address
810 LAKEVIEW DR, CROSS LANES, WV 25313-1448
(304) 543-9433
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
110057
WV
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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