MEDICARE: PAMELA M GARDNER C.N.P

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	363LN0000X	Neonatal Nurse Practitioner	APRN.CNP.01529	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1174571350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA M GARDNER C.N.P

Provider Business Mailing Address
First Line	:	8880 TOPAZ TER
Second Line	:
City	:	STREETSBORO
State	:	OH
Zip	:	44241-4109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3497
Country	:	US
Telephone Number	:	440-816-6751
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/17/2024

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