Provider Demographics
NPI:1053918094
Name:SANGLERAT, JANEL NICOLE
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:NICOLE
Last Name:SANGLERAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1032
Mailing Address - Country:US
Mailing Address - Phone:844-527-7369
Mailing Address - Fax:
Practice Address - Street 1:416 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1032
Practice Address - Country:US
Practice Address - Phone:844-527-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015507363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care