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NPI Code Detail

MEDICARE: TINA MARIE GANT

MEDICARE: TINA MARIE GANT
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
1183700000XPharmacy TechnicianCPT0009907OR

General Provider Information

NPI Number : 1467147629
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE GANT
Provider Business Mailing Address
First Line : 514 NE 181ST AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-6702
Country : US
Telephone Number : 503-661-6991
Fax Number : 503-661-0615
Provider Business Practice Location Address
First Line : 514 NE 181ST AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-6702
Country : US
Telephone Number : 503-661-6991
Fax Number : 503-661-0615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2023
Last Update Date : 04/05/2023

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Directions to “ TINA MARIE GANT ” Practice Location

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