Provider Demographics
NPI:1992186019
Name:GANNON, LECIA CHRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:LECIA
Middle Name:CHRISTINE
Last Name:GANNON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LECIA
Other - Middle Name:CHRISTINE
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN FNP
Mailing Address - Street 1:100 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-1177
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339702-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily