Provider Demographics
NPI:1154461648
Name:GARDNER, CHERYL DENISE (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GROVE ST APT D
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5514
Mailing Address - Country:US
Mailing Address - Phone:516-565-4091
Mailing Address - Fax:
Practice Address - Street 1:36 GROVE ST APT D
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5514
Practice Address - Country:US
Practice Address - Phone:516-565-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579960-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse