Provider Demographics
NPI:1144766726
Name:GARDNER, LAUREN MAREE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:MAREE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 NUTWOOD AVE
Mailing Address - Street 2:APT I33
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3117
Mailing Address - Country:US
Mailing Address - Phone:610-844-8014
Mailing Address - Fax:
Practice Address - Street 1:800 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3547
Practice Address - Country:US
Practice Address - Phone:657-278-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer