| Organization Name: | STACY GARDNER |
| NPI Number: | 1285806422 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACY GARDNER (FAMILY NURSE PRACTITIONER/ OWNER) |
| Mailing Address: | 410 W Saint Louis St West Frankfort |
| State: | IL US |
| Postal Code: | 628961956 |
| Phone Number: | 6189322200 |
| Fax Number: | 6189322202 |
| NPI Enumeration Date: | 03/27/2008 |
| NPI Last Update Date: | 08/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 209007026 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |