Individual
MRS. DIANE LINDA GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-5045
(631) 402-3060
Mailing address
22 WILDFLOWER DR, KINGS PARK, NY 11754-5046
(631) 402-3460
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0024164689
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
434658
NY
Other
Enumeration date
07/17/2006
Last updated
03/13/2024
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