Individual
MARY ANN T GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
200 E STATE ST, ALLIANCE, OH 44601-4936
(330) 596-7227
(330) 596-7214
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN128882
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141657
ANTHEM
—
05
—
0772945
—
OH
01
—
430053337
MEDICARE RAILROAD
—
01
—
8206166
MEDICARE PTAN
OH
Enumeration date
07/03/2006
Last updated
06/17/2019
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