Provider Demographics
NPI:1366316937
Name:GARDNER, CHANCE TAYLOR
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:TAYLOR
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 MONICA LN
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5106
Mailing Address - Country:US
Mailing Address - Phone:214-264-9961
Mailing Address - Fax:
Practice Address - Street 1:6008 MONICA LN
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5106
Practice Address - Country:US
Practice Address - Phone:214-264-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH75326926376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker