Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.01529 | OH |
NPI | 1174571350 |
---|---|
Provider Name | Pamela M Gardner |
First Address | Streetsboro, OH 44241-4109 |
Second Address | Cleveland, OH 44195-4308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 03/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2355508 | (05) | OH |