Provider Demographics
NPI:1528600707
Name:GARDNER, ALLISON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD STE M15
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2333
Mailing Address - Country:US
Mailing Address - Phone:301-441-4400
Mailing Address - Fax:
Practice Address - Street 1:6201 GREENBELT RD STE M15
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2333
Practice Address - Country:US
Practice Address - Phone:301-441-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily