Provider Demographics
NPI:1447582382
Name:GARDNER, SANDRA K (RD, LD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2827
Mailing Address - Country:US
Mailing Address - Phone:320-231-1527
Mailing Address - Fax:320-231-0796
Practice Address - Street 1:1401 16TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2827
Practice Address - Country:US
Practice Address - Phone:320-231-1527
Practice Address - Fax:320-231-0796
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered