Provider Demographics
NPI:1497757322
Name:GARD, ANNA M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:GARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ABINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4812
Mailing Address - Country:US
Mailing Address - Phone:215-886-3461
Mailing Address - Fax:
Practice Address - Street 1:1421 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2610
Practice Address - Country:US
Practice Address - Phone:215-572-7880
Practice Address - Fax:215-572-8024
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003792B363LF0000X
PAUP003792-B363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39-1882Medicare ID - Type UnspecifiedMEDICARE NUMBER