Stacy Danielle Gardner, NNP-BC

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

4704310876NSA240SW Issued in MI

Practice address

3901 Beaubien St
Detroit, MI 48201-2119

Phone

(313) 966-8341

Fax

(313) 966-6121

NPI assigned

Sep 16, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1801623806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9792 SEAVITT DR",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481011293",
            "telephone_number": "734-776-2279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012119",
            "telephone_number": "313-966-8341",
            "fax_number": "313-966-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "STACY",
        "middle_name": "DANIELLE",
        "credential": "NNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "MI",
            "license": "4704310876NSA240SW",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhonda Gardner, RN
• Rondalyn Michelle Gardner
• Shaniqua Gardner
• Sharon Marie Gardner
• Sierra Gardner, LMSW
• Victorio M. Gardner, PSY.D.
• Yolanda Michelle Gardner
• Adele Xenia Gardynik
• Alec Garfinkel, MD
• Anureet K Garg, D.O.

• Critical Care Neonatal Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Critical Care Neonatal Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.