Individual
ANDREA BETH GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3500 POTOMAC WAY STE 100, IDAHO FALLS, ID 83404-4977
(208) 522-7666
Mailing address
3500 POTOMAC WAY STE 100, IDAHO FALLS, ID 83404-4977
(208) 522-7666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10197766-1206
UT
363A00000X
Physician Assistant
Primary
PA-1622
ID
Other
Enumeration date
01/03/2017
Last updated
09/22/2022
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