Provider Demographics
NPI:1982384947
Name:GARDEWINE, ZACHARY ANTHONY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ANTHONY
Last Name:GARDEWINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CAMPUS EDGE DR APT 204A
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4004
Mailing Address - Country:US
Mailing Address - Phone:217-343-7384
Mailing Address - Fax:
Practice Address - Street 1:SIUE SCHOOL OF NURSING ALUMNI HALL ROOM 2117
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-0001
Practice Address - Country:US
Practice Address - Phone:618-650-3956
Practice Address - Fax:618-650-3854
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program