Provider Demographics
NPI:1992490908
Name:JIANG, GAHNTANUCH (FNP-C)
Entity type:Individual
Prefix:
First Name:GAHNTANUCH
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MILD
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2012
Mailing Address - Country:US
Mailing Address - Phone:314-747-5866
Mailing Address - Fax:314-747-5866
Practice Address - Street 1:5000 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2012
Practice Address - Country:US
Practice Address - Phone:314-747-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017021507163W00000X
MO2023004935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse