Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 20A6134 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | 7383A | WY |
N | 207RC0000X | Internist - Cardiovascular Disease | 822 | NV |
Y | 207RC0000X | Internist - Cardiovascular Disease | DO194314 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | OP60308505 | WA |
NPI | 1033101696 |
---|---|
Provider Name | Dr. Geraldine Gardner |
First Address | La Grande, OR 97850-7290 |
Second Address | La Grande, OR 97850-1387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 13/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123264900 | (05) | WY |
2016356 | (05) | NV |
500769777 | (05) | OR |
F15539 | (02) | NV |
G8914098 | (02) | WA |