Provider Demographics
NPI:1396367785
Name:GAULRAPP, JEFFREY ALAN (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:GAULRAPP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 REVOLUTIONARY PATH
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5951
Mailing Address - Country:US
Mailing Address - Phone:315-420-6093
Mailing Address - Fax:
Practice Address - Street 1:UPSTATE UNIVERSITY HOSPITAL COMMUNITY GENERAL CAMPUS
Practice Address - Street 2:4900 BROAD ROAD
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-559-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY669646-1367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY669646-1OtherUNIVERSITY OF THE STATE OF NEW YORK OFFICE OF THE PROFESSIONS LICENSE NUMBER