Provider Demographics
NPI:1255907879
Name:GARDNER, HEATHER MARIE (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
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 1:39051 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:GRAYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45734-9996
Mailing Address - Country:US
Mailing Address - Phone:740-525-5255
Mailing Address - Fax:
Practice Address - Street 1:67670 TRACO DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9375
Practice Address - Country:US
Practice Address - Phone:740-695-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.409690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse