Provider Demographics
NPI:1891763942
Name:GARDINER, CHRISTLIEB E (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTLIEB
Middle Name:E
Last Name:GARDINER
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2153
Mailing Address - Country:US
Mailing Address - Phone:785-263-2100
Mailing Address - Fax:785-263-6676
Practice Address - Street 1:511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2153
Practice Address - Country:US
Practice Address - Phone:785-263-2100
Practice Address - Fax:785-263-6676
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR32058Medicare UPIN
KS426894Medicare ID - Type Unspecified