Provider Demographics
NPI:1548613730
Name:JUENEMANN, GAYLE K (ARNP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:K
Last Name:JUENEMANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 WAINWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1946
Mailing Address - Country:US
Mailing Address - Phone:206-963-9012
Mailing Address - Fax:202-548-8600
Practice Address - Street 1:810 5TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:206-963-9012
Practice Address - Fax:202-548-8600
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60681419363LF0000X
DCRN1049286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily