Provider Demographics
NPI:1659531432
Name:GARDNER, JARREAU E (MS, RD, CN)
Entity Type:Individual
Prefix:MS
First Name:JARREAU
Middle Name:E
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS, RD, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 RAINIER AVE N UNIT C315
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5396
Mailing Address - Country:US
Mailing Address - Phone:206-226-2013
Mailing Address - Fax:
Practice Address - Street 1:8266 LAKE CITY WAY NE
Practice Address - Street 2:SUITE 3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4475
Practice Address - Country:US
Practice Address - Phone:206-226-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered