Healthcare Provider Details

I. General information

NPI: 1164759502
Provider Name (Legal Business Name): LEEANNA K GARDNER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEANNA KRABILL

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 HOSPITAL DR STE 290
DUBLIN OH
43016-9641
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8883
  • Fax: 614-566-8149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10838NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10838-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: