Healthcare Provider Details

I. General information

NPI: 1023488137
Provider Name (Legal Business Name): BRITTNIE GARDNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 NEW BERN AVE
RALEIGH NC
27610-1821
US

IV. Provider business mailing address

2610 NEW BERN AVE
RALEIGH NC
27610-1821
US

V. Phone/Fax

Practice location:
  • Phone: 919-403-4820
  • Fax:
Mailing address:
  • Phone: 199-403-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number251G00000X
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5007955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: