Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 5007955 | NC |
NPI | 1023488137 |
---|---|
Provider Name | Brittnie Gardner |
First Address | Raleigh, NC 27610-1821 |
Second Address | Raleigh, NC 27610-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2015 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3401523 | (05) | NC |