Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2021-01511 | NC |
N | 207PP0204X | Pediatric Emergency Physician | 2021-01511 | NC |
NPI | 1275037244 |
---|---|
Provider Name | Dr. Dana Watson Gans |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 27/10/2021 |