Provider Demographics
NPI:1831136316
Name:GARDNER, DENISE ELAINE (CRNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ELAINE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:HITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1942 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1942 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1051081363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00033186OtherRAILROAD MEDICARE
AL051515015OtherBLUE CROSS BLUE SHIELD AL
AL051515015Medicaid
AL051515015Medicaid
ALP00033186OtherRAILROAD MEDICARE