Provider Demographics
NPI:1124620125
Name:GARNER, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GARNER
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 1:14375 BERLIN STATION RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44401-9775
Mailing Address - Country:US
Mailing Address - Phone:330-540-1055
Mailing Address - Fax:
Practice Address - Street 1:10299 NEW BUFFALO RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9196
Practice Address - Country:US
Practice Address - Phone:330-881-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318359Medicaid