Provider Demographics
NPI:1487205399
Name:GARDNER, RITA PHILOMENA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:PHILOMENA
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 1:8104 S 166TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-3158
Mailing Address - Country:US
Mailing Address - Phone:402-895-1345
Mailing Address - Fax:402-895-1345
Practice Address - Street 1:8104 S 166TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-3158
Practice Address - Country:US
Practice Address - Phone:402-895-1345
Practice Address - Fax:402-895-1345
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide