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General NPI Number Information
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NPI Number | 1376872606
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Entity Type | Individual
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Provider Name | TAMMY L GANNAWAY FNP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 37 PARK ST
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City | LEWISTON
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State | ME
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Zip | 04240-7195
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Country | US
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Telephone | 207-333-1080
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Fax | 207-777-4649
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Provider Business Mailing Address
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Address Line | PO BOX 2621
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City | WATERVILLE
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State | ME
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Zip | 04903-2621
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Country | US
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Telephone | 207-272-0638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN001615
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP91069
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License Number State | ME
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