Provider Demographics
NPI:1346625829
Name:GAMBRAH, ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GAMBRAH
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 1:6325 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2036
Mailing Address - Country:US
Mailing Address - Phone:215-729-6026
Mailing Address - Fax:215-729-6046
Practice Address - Street 1:6325 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2036
Practice Address - Country:US
Practice Address - Phone:215-729-6026
Practice Address - Fax:215-729-6046
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014707363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner