Basic Information
| Provider Information | |||||||||
| NPI: | 1508954421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARDNER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3441 CARSON RD | ||||||||
| Address2: | |||||||||
| City: | CAMINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306479704 | ||||||||
| FaxNumber: | 5306448420 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 MARSHALL WAY | ||||||||
| Address2: | MARSHALL HOSPITAL | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306221441 | ||||||||
| FaxNumber: | 5306228655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 468480 | CA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.