Individual
MICHELLE A GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
R032905
ME
363LF0000X
Family Nurse Practitioner
Primary
AP081584
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010507276
TAX ID
ME
01
—
100544
ANTHEM
ME
05
—
247850099
—
ME
Enumeration date
06/22/2006
Last updated
04/10/2020
Update your record
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