Gardiner, Shannon L

Gardiner, Shannon L is an individual health care provider with primary practice located at 875 S Vanguard Way Ste 200 , Meridian ID 83642-8542. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Gardiner, Shannon L can be contacted via phone (208) 809-2895.

Contact Information

Primary practice address
875 S Vanguard Way Ste 200 Meridian ID 83642-8542
Phone: (208) 809-2895
Fax: (208) 809-2896
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA403 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-403 Idaho

Profile Details

NPI number 1689701260
LBN Legal business name Gardiner, Shannon L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2007
Last updated Apr 24th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689701260 NPPES
Idaho MEDICAID 806483300

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