Provider Demographics
NPI:1073595930
Name:GARDNER, APRIL LYNN (MSBS, PA-C)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:LYNN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSBS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 BUTZ ROAD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-376-6940
Mailing Address - Fax:
Practice Address - Street 1:3632 BUTZ RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9691
Practice Address - Country:US
Practice Address - Phone:419-376-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001791363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGAPA24591OtherPIN
OH9265771Medicare ID - Type Unspecified
OHGAPA24591OtherPIN