Provider Demographics
NPI:1245986850
Name:GARNER, NINA MARIE (CST/CSFA)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE
Last Name:GARNER
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:MARIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 INVERNESS BLVD
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-4580
Mailing Address - Country:US
Mailing Address - Phone:130-732-1804
Mailing Address - Fax:
Practice Address - Street 1:2221 ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5108
Practice Address - Country:US
Practice Address - Phone:307-324-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY208217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery