Provider Demographics
NPI:1982247169
Name:GARDNER, LORETTA BERNADETTE
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:BERNADETTE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:BERNADETTE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:589 WEST OCEANVIEW #2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503
Mailing Address - Country:US
Mailing Address - Phone:757-345-1035
Mailing Address - Fax:
Practice Address - Street 1:589 WEST OCEANVIEW #2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503
Practice Address - Country:US
Practice Address - Phone:757-345-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider