Provider Demographics
NPI:1992106769
Name:SUNKEL, GWENDOLYN (NP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:SUNKEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CROSS POINTE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:614-577-1427
Practice Address - Street 1:10967 ALLISONVILLE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2632
Practice Address - Country:US
Practice Address - Phone:317-436-1222
Practice Address - Fax:317-288-0083
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005143A363LF0000X, 363L00000X
IN28172723A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2019004Medicare PIN
INP01424404OtherMEDICARE RAILROAD PTAN