Provider Demographics
NPI:1174661540
Name:GARDNER, EDWARD (RN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3146
Mailing Address - Country:US
Mailing Address - Phone:951-788-8131
Mailing Address - Fax:
Practice Address - Street 1:1700 IOWA AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2420
Practice Address - Country:US
Practice Address - Phone:951-369-8604
Practice Address - Fax:951-715-4594
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280999163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator