Individual
MARY JUDITH GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
655 KENMOOR AVE SE STE 101, GRAND RAPIDS, MI 49546-8622
(616) 900-9911
(616) 900-9862
Mailing address
655 KENMOOR AVE SE STE 101, GRAND RAPIDS, MI 49546-8622
(616) 900-9911
(616) 900-9862
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704281984
MI
Other
Enumeration date
04/22/2021
Last updated
12/06/2021
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