Provider Demographics
NPI:1629409461
Name:GARDNER, JOSEPH (ARNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 6TH AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1759
Mailing Address - Country:US
Mailing Address - Phone:206-356-7503
Mailing Address - Fax:
Practice Address - Street 1:1511 6TH AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1759
Practice Address - Country:US
Practice Address - Phone:206-356-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60429654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily