Healthcare Provider Details

I. General information

NPI: 1548288137
Provider Name (Legal Business Name): NANCY GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E MAHANOY ST
MAHANOY CITY PA
17948-3006
US

IV. Provider business mailing address

1205 E MAHANOY ST
MAHANOY CITY PA
17948-3006
US

V. Phone/Fax

Practice location:
  • Phone: 520-906-8494
  • Fax:
Mailing address:
  • Phone: 520-906-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN219868L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: