Provider Demographics
NPI:1902179252
Name:GARTNER, PATRICK CHRISTOPHER (RN)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:GARTNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 GARDEN GROVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-9596
Mailing Address - Country:US
Mailing Address - Phone:805-641-1890
Mailing Address - Fax:
Practice Address - Street 1:958 GARDEN GROVE DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-9596
Practice Address - Country:US
Practice Address - Phone:805-641-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030517LPN164W00000X
CA235539164X00000X
OR201340322RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse