Provider Demographics
NPI:1497892095
Name:GARDINER, LYNETTE A (ARNP, MN, CS)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:A
Last Name:GARDINER
Suffix:
Gender:F
Credentials:ARNP, MN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 5TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1580
Mailing Address - Country:US
Mailing Address - Phone:425-290-3452
Mailing Address - Fax:425-353-1042
Practice Address - Street 1:627 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1580
Practice Address - Country:US
Practice Address - Phone:425-290-3452
Practice Address - Fax:425-353-1042
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003907101YM0800X
WARN00045658163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health