Healthcare Provider Details

I. General information

NPI: 1033485610
Provider Name (Legal Business Name): JANETT LEE GARDNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date: 01/27/2023
Reactivation Date: 09/10/2024

III. Provider practice location address

3012 GLENMORE AVE STE 104
CINCINNATI OH
45238-2258
US

IV. Provider business mailing address

9 CHESAPEAKE PLZ
CHESAPEAKE OH
45619-1003
US

V. Phone/Fax

Practice location:
  • Phone: 513-914-1815
  • Fax: 513-914-1815
Mailing address:
  • Phone: 513-914-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.371438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: