Provider Demographics
NPI:1437213543
Name:GAN, MICHELLE SY
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SY
Last Name:GAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 YORKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-9305
Mailing Address - Country:US
Mailing Address - Phone:757-833-6179
Mailing Address - Fax:
Practice Address - Street 1:848 YORKSHIRE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-9305
Practice Address - Country:US
Practice Address - Phone:757-314-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001144137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse