Provider Demographics
NPI:1730501602
Name:PATTI GARDNER PC
Entity Type:Organization
Organization Name:PATTI GARDNER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-476-7557
Mailing Address - Street 1:4444 SOUTH 86TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 SOUTH 86TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111008363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026386502Medicaid
NE1588879662OtherNPI