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General NPI Number Information
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NPI Number | 1417028861
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Entity Type | Individual
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Provider Name | MRS. SANDRA YVONNE GARDNER
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 9953 LEWIS AND CLARK BLVD STE 106
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City | SAINT LOUIS
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State | MO
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Zip | 63136-5336
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Country | US
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Telephone | 314-868-4888
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Fax | 314-868-2291
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Provider Business Mailing Address
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Address Line | 1250 EDGEWATER DR
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City | SAINT LOUIS
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State | MO
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Zip | 63137-1105
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Country | US
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Telephone | 314-868-4888
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Fax | 314-868-2291
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 73832311898322
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License Number State | MO
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