Provider Demographics
NPI:1811010325
Name:GARDNER, JULIE DENISE (RN)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:DENISE
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 1:10224 LITTLE T
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3562
Mailing Address - Country:US
Mailing Address - Phone:832-207-9820
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 927
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5204
Practice Address - Country:US
Practice Address - Phone:713-797-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719999163WM0705X, 163WP2201X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery