Provider Demographics
NPI:1548220247
Name:SANDOVAL, GALE (RNC, NP)
Entity Type:Individual
Prefix:MRS
First Name:GALE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 W MICHIGAN AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1900
Mailing Address - Country:US
Mailing Address - Phone:517-768-0600
Mailing Address - Fax:517-768-0606
Practice Address - Street 1:744 W MICHIGAN AVE
Practice Address - Street 2:STE 300
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1900
Practice Address - Country:US
Practice Address - Phone:517-768-0600
Practice Address - Fax:517-768-0606
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470127920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP91665Medicare UPIN