MEDICARE: MS. SANDRA GAUTHIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	AG03250053	PA

General Provider Information

NPI Number	:	1588451272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA GAUTHIER

Provider Business Mailing Address
First Line	:	7101 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1039
Country	:	US
Telephone Number	:	267-444-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1039
Country	:	US
Telephone Number	:	267-444-4266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	01/14/2026

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Directions to “ MS. SANDRA GAUTHIER ” Practice Location

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