NPI | 1386700607 |
---|---|
Former Name | DIANE M GARDNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400548) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F330063) |
Enumeration Date | 2006-12-29 |
Last Update Date | 2011-07-12 |