Provider Demographics
NPI:1447578026
Name:GARDNER, JOHN (CNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2564
Mailing Address - Country:US
Mailing Address - Phone:740-345-2767
Mailing Address - Fax:888-721-4952
Practice Address - Street 1:44 S 29TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2564
Practice Address - Country:US
Practice Address - Phone:740-345-2767
Practice Address - Fax:888-721-4952
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN222488-COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily