MEDICARE: CHRISTINE J GANN

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
1	175T00000X	Peer Specialist	134600	OK
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1336911262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE J GANN

Provider Business Mailing Address
First Line	:	PO BOX 182
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74602-0182
Country	:	US
Telephone Number	:	580-686-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 N UNION ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2440
Country	:	US
Telephone Number	:	580-686-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	12/19/2024

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Directions to “ CHRISTINE J GANN ” Practice Location

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