MEDICARE: LINDSEY GARDINER

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1841857570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY GARDINER

Provider Business Mailing Address
First Line	:	1504 E 107TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 E 107TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1830
Country	:	US
Telephone Number	:	614-906-0777
Fax Number	:

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	11/04/2019

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Directions to “ LINDSEY GARDINER ” Practice Location

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