Provider Demographics
NPI:1952403172
Name:SULANDER, GAIL I (MS RD CDE)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:I
Last Name:SULANDER
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2864 ASHMUN STREET
Mailing Address - Street 2:SAULT TRIBAL HEALTH CENTER
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783
Mailing Address - Country:US
Mailing Address - Phone:906-632-5200
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:6596 W US HIGHWAY 2
Practice Address - Street 2:MANISTIQUE TRIBAL HEALTH CENTER
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-341-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P56271Medicare UPIN