Provider Demographics
NPI:1538293345
Name:GAMBILL, SALLY R (CNM, RN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:R
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:PINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-0813
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-481-0486
Practice Address - Street 1:728 S BEAVER ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-2209
Practice Address - Country:US
Practice Address - Phone:610-481-0481
Practice Address - Fax:610-481-0486
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN293115L163W00000X
PAMW010142176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse