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General NPI Number Information
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NPI Number | 1144888488
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Entity Type | Individual
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Provider Name | DESTINEE MARKIA GARDNER
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Gender | Female
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Dates
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Enumeration Date | 06/02/2019
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Last Update Date | 06/02/2019
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Provider Practice Location Address
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Address Line | 525 SEVILLE RD
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City | GREENVILLE
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State | NC
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Zip | 27834-4890
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Country | US
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Telephone | 252-814-3089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 332
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City | ROBERSONVILLE
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State | NC
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Zip | 27871-0332
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Country | US
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Telephone | 252-902-4606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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