Provider Demographics
NPI:1912153032
Name:GARDNER, JOANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:DUBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:27 MARBOY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1517
Mailing Address - Country:US
Mailing Address - Phone:860-628-2371
Mailing Address - Fax:
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:116A1
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-594-6365
Practice Address - Fax:860-667-6872
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE39723163WP0808X
CT005233363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health