Provider Demographics
NPI:1033826250
Name:GARDNER, LYNN ANN (RN,BSN)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GOLDEN BEAR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1670
Mailing Address - Country:US
Mailing Address - Phone:304-387-2363
Mailing Address - Fax:304-387-4624
Practice Address - Street 1:39 GOLDEN BEAR DR
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-1670
Practice Address - Country:US
Practice Address - Phone:304-387-2363
Practice Address - Fax:304-387-4624
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV85203163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV85203OtherRN/SCHOOL NURSE