Provider Demographics
NPI:1619253861
Name:GARDINIER, ROSEANN MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:MARIE
Last Name:GARDINIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1127
Mailing Address - Country:US
Mailing Address - Phone:315-697-6341
Mailing Address - Fax:315-697-6368
Practice Address - Street 1:120 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-1127
Practice Address - Country:US
Practice Address - Phone:315-697-6341
Practice Address - Fax:315-697-6368
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY523947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse