Provider Demographics
NPI:1396915294
Name:GARDINER, DAWN MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7874 VAN NESS RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840
Mailing Address - Country:US
Mailing Address - Phone:607-329-2797
Mailing Address - Fax:
Practice Address - Street 1:22 QUEEN ANN STREET
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:NY
Practice Address - Zip Code:14739-8606
Practice Address - Country:US
Practice Address - Phone:607-329-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2370481164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01822811Medicaid