Provider Demographics
NPI:1639412703
Name:GARDNER, NYLA RAE (PMHNP)
Entity Type:Individual
Prefix:
First Name:NYLA
Middle Name:RAE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:NYLA
Other - Middle Name:RAE
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 NASHUA RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3426
Mailing Address - Country:US
Mailing Address - Phone:603-818-8926
Mailing Address - Fax:603-818-8928
Practice Address - Street 1:80 NASHUA RD
Practice Address - Street 2:SUITE B2
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3426
Practice Address - Country:US
Practice Address - Phone:603-818-8926
Practice Address - Fax:603-818-8928
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH036181-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health