Provider Demographics
NPI:1013556729
Name:GARDECKI, MEGHAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GARDECKI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BARBICAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:ST CATHARINES
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2T4A9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 BARBICAN TRAIL
Practice Address - Street 2:
Practice Address - City:ST CATHARINES
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2T4A9
Practice Address - Country:CA
Practice Address - Phone:226-387-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751395-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty