Provider Demographics
NPI:1871799494
Name:GALLANT WOOD, JANET M (MSN,ANP-BC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:GALLANT WOOD
Suffix:
Gender:F
Credentials:MSN,ANP-BC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:M
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN,RNC
Mailing Address - Street 1:620 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1328
Mailing Address - Country:US
Mailing Address - Phone:781-279-4064
Mailing Address - Fax:
Practice Address - Street 1:620 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1328
Practice Address - Country:US
Practice Address - Phone:781-279-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168375363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health