Healthcare Provider Details

I. General information

NPI: 1548220247
Provider Name (Legal Business Name): GALE SANDOVAL RNC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W MICHIGAN AVE STE 300
JACKSON MI
49201-1900
US

IV. Provider business mailing address

744 W MICHIGAN AVE STE 300
JACKSON MI
49201-1900
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0600
  • Fax: 517-768-0606
Mailing address:
  • Phone: 517-768-0600
  • Fax: 517-768-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number470127920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: