Individual
TERA GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4005 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5906
(505) 462-6000
(505) 727-9590
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2016009388
MO
363LF0000X
Family Nurse Practitioner
53-77233-122
KS
363LF0000X
Family Nurse Practitioner
Primary
54686
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96533544
—
NM
Enumeration date
03/28/2016
Last updated
02/10/2022
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