Healthcare Provider Details

I. General information

NPI: 1730501602
Provider Name (Legal Business Name): PATTI GARDNER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 10/12/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 SOUTH 86TH ST SUITE 102
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

4444 SOUTH 86TH ST SUITE 102
LINCOLN NE
68526-9253
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone: 402-476-7557
  • Fax: 402-476-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number111008
License Number StateNE

VIII. Authorized Official

Name: PATTI F GARDNER
Title or Position: OWNER
Credential: APRN
Phone: 402-476-7557