Individual
MRS. SHANNON L GARDINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
875 S VANGUARD WAY STE 200, MERIDIAN, ID 83642-8542
(208) 809-2895
(208) 809-2896
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 985-1423
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA403
ID
363AS0400X
Surgical Physician Assistant
Primary
PA-403
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806483300
—
ID
Enumeration date
02/28/2007
Last updated
04/24/2024
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