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General NPI Number Information
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NPI Number | 1235908567
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Entity Type | Individual
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Provider Name | JENNIFER PAULINE GARDNER FNP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 217 DIVISION AVE
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City | EUGENE
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State | OR
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Zip | 97404-5429
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Country | US
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Telephone | 541-780-6654
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Fax |
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Provider Business Mailing Address
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Address Line | 557 HONEYSUCKLE LN
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City | EUGENE
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State | OR
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Zip | 97401-5308
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Country | US
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Telephone | 541-954-1173
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202005793
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10023094
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10023094
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License Number State | OR
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