Healthcare Provider Details

I. General information

NPI: 1366493140
Provider Name (Legal Business Name): KELLEY RHENE GARDNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 TIMBERLAKE METHODIST HOSPITAL
SACRAMENTO CA
95823
US

IV. Provider business mailing address

PO BOX 966 SUTTER CREEK OB ANESTHESIA
SUTTER CREEK CA
95685
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone: 888-270-0340
  • Fax: 888-270-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN244086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: