Active NPI
Brandon Micheal Gardner, BRANDON GARDNER
- Licensed Practical Nurse
- Ravenna, OH
National Provider Identifier
1770802977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 137773
- Practice address
- 3561 Work Rd
Ravenna, OH 44266-9792 - Phone
- (440) 429-5052
- NPI assigned
- May 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 137773 | OH | Primary |
Addresses
Primary practice location
3561 Work Rd
Ravenna, OH 44266-9792
Mailing address
3561 Work Rd
Ravenna, OH 44266-9792
Phone (440) 429-5052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137773 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274918400000",
"number": "1770802977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3561 WORK RD",
"city": "RAVENNA",
"state": "OH",
"postal_code": "442669792",
"telephone_number": "440-429-5052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3561 WORK RD",
"city": "RAVENNA",
"state": "OH",
"postal_code": "442669792",
"telephone_number": "440-429-5052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "BRANDON",
"middle_name": "MICHEAL",
"credential": "BRANDON GARDNER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-27",
"last_updated": "2010-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "137773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ravenna, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.