Provider Demographics
NPI:1427523893
Name:GARDNER, SARAH JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:BACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-8130
Mailing Address - Fax:510-506-7726
Practice Address - Street 1:500 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1103
Practice Address - Country:US
Practice Address - Phone:510-204-8130
Practice Address - Fax:510-506-7726
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant