Doctor Name: | MS. JEAN ANN GARDNER |
NPI Number: | 1124186044 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | R092707 |
Business Practice Address: | 10810 Connecticut Avenue Kensington, MD - 208952138 |
Business Phone Number: | 3019297507 |
Business Fax Number: | 3019297114 |
Mailing Address: | Kaiser Permanente Mid Atlantic Permanente Medical Group, 2101 E Jefferson St Ppqa Medicare Compliance Unit 6 W ROCKVILLE |
State: | MD |
Postal Code: | 208524908 |
Phone Number: | 3018166660 |
Fax Number: | 3018166308 |
NPI Enumeration Date: | 12/04/2006 |
NPI Last Update Date: | 11/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R092707 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |