Provider Demographics
NPI:1083704290
Name:GARDNER, NANCY BETH (RNFA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BETH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 MCDOWELL DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4226
Mailing Address - Country:US
Mailing Address - Phone:817-685-7102
Mailing Address - Fax:
Practice Address - Street 1:2205 MCDOWELL DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-4226
Practice Address - Country:US
Practice Address - Phone:817-685-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628564163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066KEOtherBC/BS