Provider Demographics
NPI:1235357021
Name:GARDNER, MARY ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
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 1:4313 OWENSBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9792
Mailing Address - Country:US
Mailing Address - Phone:410-867-7505
Mailing Address - Fax:
Practice Address - Street 1:791 AQUAHART RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3961
Practice Address - Country:US
Practice Address - Phone:410-222-6838
Practice Address - Fax:410-222-6840
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124584163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool