Provider Demographics
NPI:1699171033
Name:GARDNER, RACHEL (LVN)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GARDNER WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1023 CHADWICK CIR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3292
Mailing Address - Country:US
Mailing Address - Phone:925-238-1535
Mailing Address - Fax:
Practice Address - Street 1:1410 BONITA AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1909
Practice Address - Country:US
Practice Address - Phone:510-526-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172215164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse