Provider Demographics
NPI:1497986293
Name:GARDNER, DAWN MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:SLUSARCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:195 WADSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9504
Mailing Address - Country:US
Mailing Address - Phone:330-331-1510
Mailing Address - Fax:330-331-1923
Practice Address - Street 1:195 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9504
Practice Address - Country:US
Practice Address - Phone:330-331-1510
Practice Address - Fax:330-331-1923
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner