Provider Demographics
NPI:1790305803
Name:GARDNER, ANQUINETTE MICHELLE (NEMT TRANSPORTATION)
Entity Type:Individual
Prefix:
First Name:ANQUINETTE
Middle Name:MICHELLE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:NEMT TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CHESTNUT ST # 5
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4301
Mailing Address - Country:US
Mailing Address - Phone:501-404-0666
Mailing Address - Fax:501-404-9722
Practice Address - Street 1:911 CHESTNUT ST # 5
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4301
Practice Address - Country:US
Practice Address - Phone:501-404-0666
Practice Address - Fax:501-404-9722
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications