Provider Demographics
NPI:1902025463
Name:GARDNER, BARBARA (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 BOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3222
Mailing Address - Country:US
Mailing Address - Phone:419-475-9768
Mailing Address - Fax:419-474-8948
Practice Address - Street 1:5555 GLENDON CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3249
Practice Address - Country:US
Practice Address - Phone:419-474-8937
Practice Address - Fax:419-474-8948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 250167171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator