Individual
JACQUELINE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
45 MOHOULI ST, HILO, HI 96720-7210
(808) 896-5569
Mailing address
HC 2 BOX 6074, KEAAU, HI 96749-8300
(808) 982-7809
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
AMD 59
HI
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN 17
HI
Other
Enumeration date
05/23/2009
Last updated
10/26/2011
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