Basic Information
| Provider Information | |||||||||
| NPI: | 1235395286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANNON | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | FARRELL | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 BERNADINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236024499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579473838 | ||||||||
| FaxNumber: | 7578866751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 BERNARDINE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236024404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579473838 | ||||||||
| FaxNumber: | 7578866751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0024166408 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.