Provider Demographics
NPI:1154618668
Name:GARDNER, EVELYN FAYE (LVN)
Entity type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:FAYE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14908 TEXACO AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3316
Mailing Address - Country:US
Mailing Address - Phone:562-396-3939
Mailing Address - Fax:
Practice Address - Street 1:14908 TEXACO AVE
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3316
Practice Address - Country:US
Practice Address - Phone:562-396-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN202744164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse