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General NPI Number Information
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NPI Number | 1366488892
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Entity Type | Individual
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Provider Name | MICHELLE A GARDNER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 489 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-6616
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Country | US
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Telephone | 207-973-7000
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Fax | 207-973-7394
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD SUITE 300
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City | BREWER
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State | ME
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Zip | 04412-1005
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Country | US
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Telephone | 207-973-5035
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Fax | 207-973-5042
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | R032905
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License Number State | ME
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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 | AP081584
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License Number State | ME
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