Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1376052571 |
---|---|
Provider Name | Beatrice Gardiner |
First Address | Rockwall, TX 75032-5695 |
Second Address | Rockwall, TX 75032-5695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 20/09/2017 |