Provider Demographics
NPI:1598297145
Name:GARDNER, ROCHELLE (RRT, AE-C)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RRT, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NW 1ST LANE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759
Mailing Address - Country:US
Mailing Address - Phone:417-681-5196
Mailing Address - Fax:417-681-5696
Practice Address - Street 1:29 NW 1ST LANE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759
Practice Address - Country:US
Practice Address - Phone:417-681-5196
Practice Address - Fax:417-681-5696
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060139002279E1000X, 2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational
No2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care