Provider Demographics
NPI:1487719407
Name:GARDNER, KARI MARIE (LAC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 FLOWER CITY PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3037
Mailing Address - Country:US
Mailing Address - Phone:585-647-4185
Mailing Address - Fax:
Practice Address - Street 1:1695 EMPIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2128
Practice Address - Country:US
Practice Address - Phone:585-787-1960
Practice Address - Fax:585-787-1638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003357-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist