Healthcare Provider Details

I. General information

NPI: 1194050062
Provider Name (Legal Business Name): DONNA D'LAINE GARDNER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA D'LAINE CROCKETT RRT

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR 6249
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

7703 FLOYD CURL DR 6249
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-8850
  • Fax: 210-567-8852
Mailing address:
  • Phone: 210-567-8850
  • Fax: 210-567-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number55854
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: