Healthcare Provider Details

I. General information

NPI: 1689402489
Provider Name (Legal Business Name): JOANNA L. GAERTNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA L. GARTNER

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S LOS ROBLES AVE # 501
PASADENA CA
91101-2453
US

IV. Provider business mailing address

285 N HOLLISTON AVE APT 4
PASADENA CA
91106-1545
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-3016
  • Fax:
Mailing address:
  • Phone: 650-766-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95164135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: