Provider Demographics
NPI:1750800850
Name:GANT, JOANNE L (LPN)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:GANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CROSS ROADS CENTER- SUITE 170
Mailing Address - Street 2:6087 STATE RTE 19 NORTH
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813
Mailing Address - Country:US
Mailing Address - Phone:585-268-5577
Mailing Address - Fax:585-268-5577
Practice Address - Street 1:6087 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9621
Practice Address - Country:US
Practice Address - Phone:585-268-5577
Practice Address - Fax:585-268-5577
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219030-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty