Individual
LAUREL M GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
85 S MIDDLETON RD, NAMPA, ID 83651-1526
(208) 505-2800
(208) 505-2801
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
—
ID
363A00000X
Physician Assistant
Primary
PA-2660
ID
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2022
Last updated
04/05/2024
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