Healthcare Provider Details

I. General information

NPI: 1386758894
Provider Name (Legal Business Name): JUDY CARMEN GARDNER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR ROAD NORTHERN CALIFORNIA HEALTH CARE SYSTEM
MARTINEZ CA
94553
US

IV. Provider business mailing address

443 VERONA AVE
DANVILLE CA
94526-2411
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax: 925-372-2830
Mailing address:
  • Phone: 925-838-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number239080
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCERTIFICATE #16
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: