=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598434219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE ANN GARDNER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2021
-----------------------------------------------------
Last Update Date | 03/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 E PEAKVIEW AVENUE HOLLY CREEK COMMUNITY
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80121-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-661-8300
-----------------------------------------------------
Fax | 973-661-8333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 BROADACRES DRIVE STE 445
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07003-9541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-661-8300
-----------------------------------------------------
Fax | 973-661-8333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | APN.0996431-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APN.0996431-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------