Individual
MICHELLE A GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 973-7000
(207) 973-7394
Mailing address
43 WHITING HILL RD, SUITE 300, BREWER, ME 04412-1005
(207) 973-5035
(207) 973-5042
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
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