Provider Demographics
NPI:1093953051
Name:GARDINER, KARLA LYNN
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:LYNN
Last Name:GARDINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 ELMIRA RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9432
Mailing Address - Country:US
Mailing Address - Phone:607-564-9421
Mailing Address - Fax:607-564-9421
Practice Address - Street 1:2912 ELMIRA RD
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-9432
Practice Address - Country:US
Practice Address - Phone:607-564-9421
Practice Address - Fax:607-564-9421
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250495-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse