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Individual
MS. TERESA DIANNE GARDNER
Active
Individual
MS. TERESA DIANNE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
224312
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088673103
—
TX
01
—
86036U
BCBSTX
TX
01
—
89781U
BCBSTX
TX
01
—
89940U
BCBS
TX
01
—
P00705780
MEDICARE RAILROAD PROVIDER
TX
Enumeration date
07/05/2006
Last updated
06/27/2010
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