Provider Demographics
NPI: | 1841792033 |
---|---|
Name: | GARDNER, SANDRA M (PCA) |
Entity Type: | Individual |
Prefix: | |
First Name: | SANDRA |
Middle Name: | M |
Last Name: | GARDNER |
Suffix: | |
Gender: | F |
Credentials: | PCA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1785 E SAHARA AVE STE 485 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89104-3757 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-562-2348 |
Mailing Address - Fax: | 702-598-0010 |
Practice Address - Street 1: | 1785 E SAHARA AVE STE 485 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89104-3757 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-562-2348 |
Practice Address - Fax: | 702-598-0010 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2018-03-02 |
Last Update Date: | 2018-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 372500000X, 372600000X, 376J00000X, 3747P1801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant |
No | 372500000X | Nursing Service Related Providers | Chore Provider | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | |
No | 376J00000X | Nursing Service Related Providers | Homemaker |