Glenda Faye Ganus, FNP
Individual provider Active NPI Nurse Practitioner · Chatom, AL
NPI 1699775643 · NPPES record last updated Feb 22, 2016
Key facts
- NPI
- 1699775643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 1-031341 (AL)
- Practice address
- 14634 Saint Stephens Ave
Chatom, AL 36518-6711 - Phone
- (251) 847-6262
- Fax
- (251) 847-6277
- NPI assigned
- Jul 29, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141119000465 | AL | Practitioner - Nurse Practitioner | 5991882359 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-031341 | AL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chatom Primary Care PC | Current |
Accepting new patients |
Locations
14634 Saint Stephens Ave
Chatom, AL 36518
Phone (251) 847-3077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-031341 | AL | Yes |
| Nurse Practitioner | 363L00000X | R856711 | MS |
Addresses
Primary practice location
14634 Saint Stephens Ave
Chatom, AL 36518-6711
Mailing address
PO Box 1237
Chatom, AL 36518-1237
Phone (251) 847-6262
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051516689 | Other | AL | MEDICARE ID |
| 529700760 | Medicaid | AL | |
| 541003926 | Other | AL | MEDICAID GROUP |
Other providers in Chatom, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.