Provider Demographics
NPI:1255313003
Name:SANJUAN, GAIL LEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:LEE
Last Name:SANJUAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:GAIL
Other - Middle Name:LEE
Other - Last Name:KOHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:ROUTE 12 BLDG 449
Mailing Address - Street 2:ATTN PROFESSIONAL AFFAIRS NAVAL AMBULATORY CARE CENTER
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:ROUTE 12 BLDG 449
Practice Address - Street 2:ATTN PROFESSIONAL AFFAIRS NAVAL AMBULATORY CARE CENTER
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5600
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-2590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR43683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN