Doctor Name: | ALISON GARDNER |
NPI Number: | 1003215542 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2149 |
Business Practice Address: | 480 Osborne Rd Ne Fridley, MN - 554322773 |
Business Phone Number: | 7637854500 |
Business Fax Number: | |
Mailing Address: | 2789 Hilltop Ct, NORTH SAINT PAUL |
State: | MN |
Postal Code: | 551091674 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/20/2014 |
NPI Last Update Date: | 08/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2149 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |