Provider Demographics
NPI:1235125675
Name:GAMBLE, CHERYL K (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0705
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3518
Practice Address - Country:US
Practice Address - Phone:302-421-4330
Practice Address - Fax:302-421-4331
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0019365163W00000X
DEL6-0A00391367500000X
PARN305816L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00766784OtherRAILROAD MEDICARE PTAN
055313OtherAANA ID#
DE012131Medicare PIN
PA169330Medicare PIN