Healthcare Provider Details

I. General information

NPI: 1013556729
Provider Name (Legal Business Name): MEGHAN GARDECKI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARBICAN TRAIL
ST CATHARINES ONTARIO
L2T4A9
CA

IV. Provider business mailing address

75 BARBICAN TRAIL
ST CATHARINES ONTARIO
L2T4A9
CA

V. Phone/Fax

Practice location:
  • Phone: 226-387-1725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number751395-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: