Provider Demographics
NPI:1649338203
Name:GARDNER, NANCY K (LAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21707 HAWTHORNE BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7011
Mailing Address - Country:US
Mailing Address - Phone:310-540-9102
Mailing Address - Fax:310-540-9104
Practice Address - Street 1:21707 HAWTHORNE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7011
Practice Address - Country:US
Practice Address - Phone:310-540-9102
Practice Address - Fax:310-540-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8053171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist