Individual
AIMEE L GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 MEDICAL PKWY, SUITE 314, CHESAPEAKE, VA 23320-4985
(757) 549-4403
(757) 549-4332
Mailing address
5900 LAKE WRIGHT DR, NORFOLK, VA 23502-1871
(757) 466-8683
(757) 466-8892
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001901
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942365077
HEALTH NET TRICARE
VA
05
—
1942365077
—
VA
Enumeration date
12/27/2006
Last updated
05/25/2010
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