Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP020914 | PA |
NPI | 1528600202 |
---|---|
Provider Name | Jenny Elizabeth Gardner |
First Address | York, PA 17402-9001 |
Second Address | York, PA 17403-3676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2019 |
Last Update Date | 05/12/2019 |