Provider Demographics
NPI:1538880828
Name:GARDNER, KIMBERLIE ALICE
Entity type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:ALICE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S BRIGHT ANGEL WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6009
Mailing Address - Country:US
Mailing Address - Phone:480-224-3200
Mailing Address - Fax:
Practice Address - Street 1:4600 S BRIGHT ANGEL WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-6009
Practice Address - Country:US
Practice Address - Phone:480-224-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN198282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse