Provider Demographics
NPI:1598434219
Name:GARDNER, NATALIE ANN
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:PREJEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:400 BROADACRES DRIVE
Mailing Address - Street 2:STE 445
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-9541
Mailing Address - Country:US
Mailing Address - Phone:973-661-8300
Mailing Address - Fax:973-661-8333
Practice Address - Street 1:5500 E PEAKVIEW AVENUE
Practice Address - Street 2:HOLLY CREEK COMMUNITY
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-3539
Practice Address - Country:US
Practice Address - Phone:973-661-8300
Practice Address - Fax:973-661-8333
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996431-NP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty