Provider Demographics
NPI:1538052543
Name:GARDNER, EMMA (CNS, LDN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 COLUMBIA PIKE
Mailing Address - Street 2:STE 300 #1227
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4439
Mailing Address - Country:US
Mailing Address - Phone:720-550-4204
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE
Practice Address - Street 2:STE 300 #1227
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4439
Practice Address - Country:US
Practice Address - Phone:720-550-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6930133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist