MEDICARE: ANISAH GARDINER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.009433RX	OH

General Provider Information

NPI Number	:	1033908280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISAH GARDINER PA-C

Provider Business Mailing Address
First Line	:	1213 NILLES RD
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2911
Country	:	US
Telephone Number	:	513-858-6900
Fax Number	:	513-858-6903

Provider Business Practice Location Address
First Line	:	1213 NILLES RD
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2911
Country	:	US
Telephone Number	:	513-858-6900
Fax Number	:	513-858-6903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	03/17/2026

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Directions to “ ANISAH GARDINER PA-C” Practice Location

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