Individual
TIMOTHY F GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4802 BROADWAY, GARY, IN 46408-4509
(219) 887-4950
Mailing address
9900 BREN RD E, MINNETONKA, MN 55343-9664
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001772B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200496760
—
IN
Enumeration date
04/14/2006
Last updated
06/29/2020
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