Individual
JENNIFER GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
901 S KOKE MILL RD, SPRINGFIELD, IL 62711-8012
(217) 528-7541
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2015007282
MO
363LF0000X
Family Nurse Practitioner
Primary
209025813
IL
Other
Enumeration date
04/02/2015
Last updated
09/10/2024
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