Individual
MR. PETER GANUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
317 WESTERN BLVD, JACKSONVILLE, NC 28546-6338
(910) 577-2471
(910) 577-2634
Mailing address
214 BATES RETREAT, MIDDLE POINT VILLAGE, HAMPSTEAD, NC 28443-2474
(910) 270-0737
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
181130
NC
367500000X
Certified Registered Nurse Anesthetist
181130
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
306
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
562014989
TRICARE
NC
05
—
6907604
—
NC
Enumeration date
04/21/2006
Last updated
02/01/2022
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