Provider Demographics
NPI:1306064472
Name:GANT, NORA (ARNP, MN)
Entity type:Individual
Prefix:MS
First Name:NORA
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:ARNP, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 3RD AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1010
Mailing Address - Country:US
Mailing Address - Phone:360-493-4504
Mailing Address - Fax:360-412-8922
Practice Address - Street 1:4525 3RD AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-493-4504
Practice Address - Fax:360-412-8922
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007610363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9652421Medicaid
WA9652421Medicaid
WAG8919463Medicare PIN
WAG8919466Medicare PIN