Provider Demographics
NPI:1093961872
Name:GARDNER, KATRINA LASHAWN
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LASHAWN
Last Name:GARDNER
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 1:4712 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-3979
Mailing Address - Country:US
Mailing Address - Phone:706-405-1744
Mailing Address - Fax:
Practice Address - Street 1:4712 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3979
Practice Address - Country:US
Practice Address - Phone:706-405-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide