MEDICARE: MR. PATRICK CHRISTOPHER GARTNER R.N.

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	164W00000X	Licensed Practical Nurse	201030517LPN	OR
2	164X00000X	Licensed Vocational Nurse	235539	CA
3	163W00000X	Registered Nurse	201340322RN	OR

General Provider Information

NPI Number	:	1902179252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK CHRISTOPHER GARTNER R.N.

Provider Business Mailing Address
First Line	:	958 GARDEN GROVE DRIVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-9596
Country	:	US
Telephone Number	:	805-641-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	958 GARDEN GROVE DRIVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-9596
Country	:	US
Telephone Number	:	805-641-1890
Fax Number	:

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

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	08/17/2020

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