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NPI Code Detail

MEDICARE: STEPHANIE ELIZABETH GARDNER NP

MEDICARE: STEPHANIE ELIZABETH 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
1363LF0000XFamily Nurse Practitioner101.0109873VT
2363L00000XNurse Practitioner1010109873VT

General Provider Information

NPI Number : 1558753871
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ELIZABETH GARDNER NP
Provider Business Mailing Address
First Line : 111 COLCHESTER AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-847-0000
Fax Number :
Provider Business Practice Location Address
First Line : 111 COLCHESTER AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-847-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2015
Last Update Date : 02/04/2026

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