Most Relevant Information
Provider Data
| NPI Number: | 1003648544 |
| Provider Name: | TIMOTHY DANIEL GARDNER |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/14/2024 |
| Last Updated: | 08/14/2024 |
Provider Practice Location
8508 W ENTIAT PL
KENNEWICK
WA
993361009
Practice Location Phone/Fax
| Phone: | 8014200269 |
| Fax: |
Provider Mailing Location
8508 W ENTIAT PL
KENNEWICK
WA
993361009
Provider Mailing Phone/Fax
| Phone: | 8014200269 |
| Fax: |