Provider Demographics
NPI:1447725924
Name:GANUNG, KATHY DEANN
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:DEANN
Last Name:GANUNG
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 1:2802 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5267
Mailing Address - Country:US
Mailing Address - Phone:541-963-3186
Mailing Address - Fax:541-963-3187
Practice Address - Street 1:2802 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-5267
Practice Address - Country:US
Practice Address - Phone:541-963-3186
Practice Address - Fax:541-963-3187
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator