Provider Demographics
NPI:1700586500
Name:GARNER, DADGRAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:DADGRAIN
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT RD STE H
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4991
Mailing Address - Country:US
Mailing Address - Phone:315-410-7499
Mailing Address - Fax:315-419-7490
Practice Address - Street 1:5112 W TAFT RD STE H
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4991
Practice Address - Country:US
Practice Address - Phone:315-410-7499
Practice Address - Fax:315-419-7490
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant