IndividualActive
Shannon Gardiner, PA
NPI 1689701260 · Surgical Physician Assistant · Meridian, ID
Provider details
- NPI number
- 1689701260
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- License
- PA403 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
875 S Vanguard Way Ste 200
Meridian, ID 83642-8542
Phone: (208) 809-2895
Fax: (208) 809-2896
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 191050
Boise, ID 83719-1050
Additional practice locations (1)
- 360 E Montvue DrSuite 100Meridian, ID 83642-6318Phone: (208) 855-2900Fax: (208) 898-9877
Registry dates
- Enumerated
- 2007-02-28
- Last updated
- 2024-04-24
- Certified
- 2024-04-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.