Individual
LACEY CAROLINE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1970 ASHLAND DR, MOUNT PLEASANT, MI 48858-1203
(989) 779-5262
(989) 772-6784
Mailing address
1970 ASHLAND DR, MOUNT PLEASANT, MI 48858-1203
(989) 779-5262
(989) 772-6784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005080
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010Z960170
BLUE CROSS BLUE SHIELD
MI
01
—
080B610040
BCBS
MI
01
—
0P43930
MEDICARE GROUP NUMBER
MI
01
—
0Z96017
MEDICARE GROUP
MI
01
—
MI1118
MEDICARE GROUP NUMBER
MI
Enumeration date
01/02/2008
Last updated
02/27/2013
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