Provider Demographics
NPI:1043537467
Name:GARDNER, JAMES RONALD (RD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RONALD
Last Name:GARDNER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROXBURY CT
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3279
Mailing Address - Country:US
Mailing Address - Phone:603-762-4873
Mailing Address - Fax:888-874-2871
Practice Address - Street 1:25 ROXBURY CT
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3279
Practice Address - Country:US
Practice Address - Phone:603-762-4873
Practice Address - Fax:888-874-2871
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered