Provider Demographics
NPI:1306000492
Name:GARDNER, ROBIN MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 LAKE ST
Mailing Address - Street 2:FRONT APT
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1029
Mailing Address - Country:US
Mailing Address - Phone:585-768-9291
Mailing Address - Fax:
Practice Address - Street 1:156 LAKE ST
Practice Address - Street 2:FRONT APT
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1029
Practice Address - Country:US
Practice Address - Phone:585-768-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse