Mary Judith Gardner
Nurse Practitioner - Gerontology
655 Kenmoor Ave Se Ste 101
Grand Rapids
, Michigan 49546-8622
Mary Judith Gardner
Nurse Practitioner - Gerontology
655 Kenmoor Ave Se Ste 101
Grand Rapids
, Michigan 49546-8622
(616) 900-9862
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About
Features
Specialties
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Mary Judith Gardner
- 655 Kenmoor Ave Se Ste 101
- Grand Rapids, MI
- Zip : 49546-8622
- Fax : (616) 900-9862
- Phone : (616) 900-9911
Second Address
- Mary Judith Gardner
- 655 Kenmoor Ave Se Ste 101
- Grand Rapids, MI
- Zip : 49546-8622
- Fax : (616) 900-9862
- Phone : (616) 900-9911
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704281984 | MI |
National Provider Identifier
| NPI | 1033791843 |
|---|---|
| Provider Name | Mary Judith Gardner |
| First Address | Grand Rapids, MI 49546-8622 |
| Second Address | Grand Rapids, MI 49546-8622 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/04/2021 |
| Last Update Date | 06/12/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.