Provider Demographics
NPI:1174883250
Name:BAETGE, GANNA (PA-C)
Entity type:Individual
Prefix:
First Name:GANNA
Middle Name:
Last Name:BAETGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 ALTOS OAKS DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5490
Mailing Address - Country:US
Mailing Address - Phone:408-495-5770
Mailing Address - Fax:650-912-1129
Practice Address - Street 1:827 ALTOS OAKS DR STE 4
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5490
Practice Address - Country:US
Practice Address - Phone:408-495-5770
Practice Address - Fax:650-912-1129
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant