Healthcare Provider Details

I. General information

NPI: 1326405762
Provider Name (Legal Business Name): BRIANNA NICOLE GAUNA MA, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH
APO AE
09461
US

IV. Provider business mailing address

PSC 41 BOX 732
APO AE
09464-0008
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-0351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001898
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: