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General NPI Number Information
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NPI Number | 1891536611
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Entity Type | Individual
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Provider Name | LAWRENCE ZACHARY GARDANIER
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Gender | Male
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 225 E WASHINGTON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3111
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Country | US
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Telephone | 870-207-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3639 RED MAPLE WAY
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City | JONESBORO
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State | AR
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Zip | 72404-5041
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Country | US
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Telephone | 801-310-5686
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 148772
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License Number State | AR
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