Individual
AMY PHYLENE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
723 SW 10TH ST, RENTON, WA 98057-5223
(206) 461-4880
Mailing address
13316 110TH AVENUE CT E, PUYALLUP, WA 98374-5618
(253) 320-4879
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000X
—
WA
Enumeration date
02/24/2023
Last updated
02/24/2023
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