Individual
MRS. SUSAN MARIE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1801 E LANGSFORD RD, LEES SUMMIT, MO 64063-6323
(816) 524-2590
(816) 524-7079
Mailing address
413E PARTRIDGE AVE, INDEPENDENCE, MO 64055-1421
(816) 522-0412
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
154843
MO
363LF0000X
Family Nurse Practitioner
46050
KS
363LP2300X
Primary Care Nurse Practitioner
Primary
154843
MO
363LP2300X
Primary Care Nurse Practitioner
46050
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154843
MO NURSING LICENSE
MO
Enumeration date
07/05/2007
Last updated
06/20/2017
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