Doctor Name: | TERESA OWENS GARDNER |
NPI Number: | 1013011337 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DNP, MSN, FNP-BC, FA |
License Number: | 0017001598 |
Business Practice Address: | 5626 Patriot Dr. Wise, VA - 24293 |
Business Phone Number: | 2763288850 |
Business Fax Number: | 2763288853 |
Mailing Address: | P.o. Box 7070, WISE |
State: | VA |
Postal Code: | 24293 |
Phone Number: | 2763288850 |
Fax Number: | 2763288853 |
NPI Enumeration Date: | 09/08/2006 |
NPI Last Update Date: | 06/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0017001598 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |