Provider Demographics
NPI:1578984043
Name:GARDNER, ELEANOR MARGARET (CNM)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARGARET
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-452-7303
Practice Address - Street 1:433 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6219
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-452-7303
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0100952367A00000X
WAAP61205935367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife