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NPI Code Detail

MEDICARE: EDNA GANTT

MEDICARE: EDNA GANTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN034576LPA

General Provider Information

NPI Number : 1326237462
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA GANTT
Provider Business Mailing Address
First Line : PO BOX 19056
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19138-0056
Country : US
Telephone Number : 215-548-1198
Fax Number :
Provider Business Practice Location Address
First Line : 2250 HICKORY RD
Second Line : SUITE 240
City : PLYMOUTH MEETING
State : PA
Zip : 19462-1047
Country : US
Telephone Number : 610-834-1122
Fax Number : 610-825-1604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2007
Last Update Date : 06/07/2026

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