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NPI Code Detail

MEDICARE: EMILY GRACE GARDNER

MEDICARE:   EMILY GRACE GARDNER
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
1363LF0000XFamily Nurse Practitioner0029894OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043982523
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY GRACE GARDNER
Provider Business Mailing Address
First Line : 60 N STYGLER RD
Second Line :
City : GAHANNA
State : OH
Zip : 43230-2435
Country : US
Telephone Number : 614-475-2014
Fax Number :
Provider Business Practice Location Address
First Line : 60 N STYGLER RD
Second Line :
City : GAHANNA
State : OH
Zip : 43230-2435
Country : US
Telephone Number : 614-475-2014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2021
Last Update Date : 02/24/2026

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