Provider Demographics
NPI:1366265506
Name:GARNER, AVA YVETTE
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:YVETTE
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:YVETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 1/2 SONORA DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1600
Mailing Address - Country:US
Mailing Address - Phone:424-331-8556
Mailing Address - Fax:
Practice Address - Street 1:223 1/2 SONORA DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1600
Practice Address - Country:US
Practice Address - Phone:424-331-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA746956164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse