Provider Demographics
NPI:1033952718
Name:GANN, MANDY LE (PMHNP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LE
Last Name:GANN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W THUNDERBIRD RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4451
Mailing Address - Country:US
Mailing Address - Phone:623-253-1226
Mailing Address - Fax:
Practice Address - Street 1:9000 W THUNDERBIRD RD STE 115
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4451
Practice Address - Country:US
Practice Address - Phone:623-253-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ325656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health