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Individual

MRS. GLENDA FAYE GANUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
14634 SAINT STEPHENS AVE, CHATOM, AL 36518-6711
(251) 847-6262
(251) 847-6277
Mailing address
PO BOX 1237, CHATOM, AL 36518-1237
(251) 847-6262
(251) 847-6277

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-031341
AL
363L00000X
Nurse Practitioner
R856711
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051516689
MEDICARE ID
AL
05
529700760
AL
01
541003926
MEDICAID GROUP
AL
Enumeration date
07/29/2005
Last updated
02/22/2016
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