Provider Demographics
NPI:1003201039
Name:GANT, MAKEDA
Entity type:Individual
Prefix:
First Name:MAKEDA
Middle Name:
Last Name:GANT
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 1:1 EMBARCADERO CTR FL 19
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:1 EMBARCADERO CTR FL 19
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3628
Practice Address - Country:US
Practice Address - Phone:415-658-6791
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991567-NP363LF0000X
OK116446363LF0000X
TX1194341363LF0000X
WAAP61645279363LF0000X
AZ316037363LF0000X
NC5021596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily