Individual provider · Type 1 NPI
Gannon Mitchell Jaquay
Student in an Organized Health Care Education/Training Program · Bear Lake, PA
NPI number
1306767660
Active
Practice location
5763 Route 958
Bear Lake, PA 16402-2931
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Athletic Trainer | 2255A2300X | None listed |
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
About NPI 1306767660
Gannon Mitchell Jaquay's National Provider Identifier is 1306767660, issued on Jul 23, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Bear Lake, PA. The record was last updated on Jul 23, 2026.