MEDICARE: NANCY VADEN GARDNER NP-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	163W00000X	Registered Nurse	28070434A	IN
2	363L00000X	Nurse Practitioner	71002326A	IN

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	:	1629116868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY VADEN GARDNER NP-C

Provider Business Mailing Address
First Line	:	5649 COVENTRY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:	260-436-6565
Fax Number	:	260-459-1130

Provider Business Practice Location Address
First Line	:	5649 COVENTRY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:	260-436-6565
Fax Number	:	260-459-1130

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	06/23/2014

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