Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 445 | NM |
N | 2251E1200X | Ergonomics | 445 | NM |
N | 225XE1200X | Ergonomics | 445 | NM |
N | 2251H1200X | Hand | 445 | NM |
N | 2251H1300X | Human Factors | 445 | NM |
N | 225XH1300X | Human Factors | 445 | NM |
N | 2251N0400X | Physical Therapist - Neurology | 445 | NM |
N | 2251P0200X | Physical Therapist - Pediatrics | 445 | NM |
N | 2251S0007X | Physical Therapist - Sports | 445 | NM |
N | 2251X0800X | Physical Therapist - Orthopedic | 445 | NM |
NPI | 1306824164 |
---|---|
Provider Name | Lorraine L Gardner |
First Address | Los Alamos, NM 87544-4102 |
Second Address | Los Alamos, NM 87544-4102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 03/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00074136 | (05) | NM |
201079804 | PRESBYTERIAN HEALTH PLAN (01) | NM |
850448868 | ALL OTHER INSURANCIES (01) | NM |
NM00Q036 | BLUECROSSBLUESHIELDS (01) | NM |