Provider Demographics
NPI:1386758894
Name:GARDNER, JUDY CARMEN (CNS)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:CARMEN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 VERONA AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-2411
Mailing Address - Country:US
Mailing Address - Phone:925-838-5492
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR ROAD
Practice Address - Street 2:NORTHERN CALIFORNIA HEALTH CARE SYSTEM
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-372-2000
Practice Address - Fax:925-372-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239080163WP0809X
CACERTIFICATE #16364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult