Provider Demographics
NPI:1114098266
Name:GARDNER, PATRICIA ANN (MED,CEIS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MED,CEIS
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:NAPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 POND ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3803
Mailing Address - Country:US
Mailing Address - Phone:781-828-4112
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-3139
Practice Address - Country:US
Practice Address - Phone:617-774-1042
Practice Address - Fax:617-847-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator