MEDICARE: ANDREA 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
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1790102929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA GANT

Provider Business Mailing Address
First Line	:	3115 GLENWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43610-1018
Country	:	US
Telephone Number	:	567-225-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 GLENWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43610-1018
Country	:	US
Telephone Number	:	567-225-1415
Fax Number	:

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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Directions to “ ANDREA GANT ” Practice Location

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