Provider Demographics
NPI:1255308292
Name:GAMBRILL, VIKKI L (CRNA)
Entity Type:Individual
Prefix:
First Name:VIKKI
Middle Name:L
Last Name:GAMBRILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VIKKI
Other - Middle Name:L
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:GPMS C/O INTERVENTIONAL PAIN GROUP
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-0269
Mailing Address - Country:US
Mailing Address - Phone:913-828-0136
Mailing Address - Fax:913-828-0296
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:STE 170
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6323
Practice Address - Country:US
Practice Address - Phone:913-828-0136
Practice Address - Fax:913-828-0296
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008908163W00000X, 367500000X
KS1373885015163W00000X
KS55066163W00000X, 163WP0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management