Provider Demographics
NPI:1457304743
Name:GAMBOTTO, MARI ANNE (NP)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:ANNE
Last Name:GAMBOTTO
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 1:2745 ILIFF ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7019
Mailing Address - Country:US
Mailing Address - Phone:303-809-9292
Mailing Address - Fax:
Practice Address - Street 1:2745 ILIFF ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-7019
Practice Address - Country:US
Practice Address - Phone:303-809-9292
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111282163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal