Healthcare Provider Details

I. General information

NPI: 1770702805
Provider Name (Legal Business Name): STEPHANIE GARDINER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST STE 585
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

PO BOX 4399
PORTLAND OR
97208-4399
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-3690
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201903627NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60798116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: