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NPI Code Detail

MEDICARE: LAKEYLA GARDNER NP

MEDICARE: LAKEYLA GARDNER NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95017057CA

General Provider Information

NPI Number : 1396211645
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKEYLA GARDNER NP
Provider Business Mailing Address
First Line : PO BOX 11247
Second Line :
City : BERKELEY
State : CA
Zip : 94712-2247
Country : US
Telephone Number : 510-981-4100
Fax Number :
Provider Business Practice Location Address
First Line : 837 ADDISON ST
Second Line :
City : BERKELEY
State : CA
Zip : 94710-2047
Country : US
Telephone Number : 510-981-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2018
Last Update Date : 10/12/2022

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