Healthcare Provider Details

I. General information

NPI: 1285814384
Provider Name (Legal Business Name): SANDRA LEE GAUKER RN, APN, C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LEE GAUKER APN

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

184 HIAWATHA BLVD
OAKLAND NJ
07436-3643
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2446
  • Fax: 201-996-4609
Mailing address:
  • Phone: 201-996-2446
  • Fax: 201-996-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NC05075500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: