Individual
STACEY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19871 W FREMONT RD, BUCKEYE, AZ 85326-9512
(602) 214-1101
Mailing address
4709 S 181ST AVE, GOODYEAR, AZ 85338-5941
(602) 214-1101
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP033900
AZ
Other
Enumeration date
02/25/2026
Last updated
02/25/2026
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