Provider Demographics
NPI:1043046469
Name:DION-GAARDE, EVA CHARLOTTE (MSED)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:CHARLOTTE
Last Name:DION-GAARDE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4312
Mailing Address - Country:US
Mailing Address - Phone:413-330-0753
Mailing Address - Fax:
Practice Address - Street 1:52 CORPORATE CIR STE 214
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5176
Practice Address - Country:US
Practice Address - Phone:518-456-4466
Practice Address - Fax:518-456-4536
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2863556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty