Individual
MISS JUANITA ANN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1505 RACE ST, MAIL STOP 503, PHILADELPHIA, PA 19102-1119
(215) 762-3083
(215) 762-1164
Mailing address
1505 RACE ST, MAIL STOP 503, PHILADELPHIA, PA 19102-1119
(215) 762-3083
(215) 762-1164
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001936L
PA
Other
Enumeration date
08/23/2013
Last updated
08/23/2013
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