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General NPI Number Information
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NPI Number | 1710469333
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Entity Type | Individual
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Provider Name | ORAWAN GARDNER
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 130 DIVISION ST
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-735-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 33 DIXWELL AVE # 191
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City | NEW HAVEN
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State | CT
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Zip | 06511-3403
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Country | US
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Telephone | 203-303-9262
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7801
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License Number State | CT
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