Provider Demographics
NPI:1568661429
Name:GIMBEL, KATHERINE JOAN (RNPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOAN
Last Name:GIMBEL
Suffix:
Gender:F
Credentials:RNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CONCORD RD
Mailing Address - Street 2:P.O. BOX 32
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-4115
Mailing Address - Country:US
Mailing Address - Phone:781-259-0525
Mailing Address - Fax:
Practice Address - Street 1:323 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:781-259-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0100285-01364SP0808X
MA123075.364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000537401Medicare PIN