Provider Demographics
NPI:1164024899
Name:JANINE GUNDEL, LLC
Entity Type:Organization
Organization Name:JANINE GUNDEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:415-717-7009
Mailing Address - Street 1:1416 NW 46TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4622
Mailing Address - Country:US
Mailing Address - Phone:415-717-7009
Mailing Address - Fax:506-934-4210
Practice Address - Street 1:188 SETTLERS HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1850
Practice Address - Country:US
Practice Address - Phone:415-717-7009
Practice Address - Fax:506-934-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty