Individual
MRS. LISA A GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, CCM
Contact information
Practice address
12150 LOFT CT, BRISTOW, VA 20136-1230
(412) 576-2106
Mailing address
12150 LOFT CT, BRISTOW, VA 20136-1230
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001221437
VA
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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