Provider Demographics
NPI:1609388727
Name:GARDNER, HANNAH MARY
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MARY
Other - Last Name:DIMMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1768 N 9TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2149
Mailing Address - Country:US
Mailing Address - Phone:303-947-6860
Mailing Address - Fax:
Practice Address - Street 1:1768 N 9TH ST APT 2
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2149
Practice Address - Country:US
Practice Address - Phone:303-947-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator