Individual
STEPHANIE C GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
5901 HARPER DR NE, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87109-3587
(505) 823-8528
(505) 823-8555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2006-0109
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
07/12/2006
Last updated
07/08/2007
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