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General NPI Number Information
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NPI Number | 1649300328
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Entity Type | Individual
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Provider Name | NOLA JEAN GARDNER RN MS FNP CDE
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5000 BRITTONFIELD PKWY STE B150
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9215
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Country | US
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Telephone | 315-766-1627
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Fax | 315-201-8711
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Provider Business Mailing Address
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Address Line | 1001 W FAYETTE ST STE 400
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City | SYRACUSE
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State | NY
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Zip | 13204-2866
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Country | US
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Telephone | 315-937-3433
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Fax | 315-937-3833
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 20510139
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License Number State | NY
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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 | 338005
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License Number State | NY
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