Provider Demographics
NPI:1891807004
Name:JOHNSEN, GALE A (FNP)
Entity type:Individual
Prefix:
First Name:GALE
Middle Name:A
Last Name:JOHNSEN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BARIBEAU DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-373-6950
Mailing Address - Fax:
Practice Address - Street 1:7 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6130
Practice Address - Country:US
Practice Address - Phone:603-447-3500
Practice Address - Fax:603-447-5568
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME81350363L00000X
NH043300-2303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH230133OtherCIGNA
NH4009273Y0NH01OtherANTHEM BCBS
NH30008840Medicare ID - Type Unspecified
NH230133OtherCIGNA
NHJONP0726Medicare ID - Type Unspecified