Provider Demographics
NPI:1417028861
Name:GARDNER, SANDRA YVONNE
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:YVONNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1105
Mailing Address - Country:US
Mailing Address - Phone:314-868-4888
Mailing Address - Fax:314-868-2291
Practice Address - Street 1:9953 LEWIS AND CLARK BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5336
Practice Address - Country:US
Practice Address - Phone:314-868-4888
Practice Address - Fax:314-868-2291
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO73832311898322251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health