Provider Demographics
NPI:1730102237
Name:GAMBAL, CHERYL ROSE (WHNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ROSE
Last Name:GAMBAL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 21 3/8 ST APT 404
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8590
Mailing Address - Country:US
Mailing Address - Phone:715-234-5448
Mailing Address - Fax:
Practice Address - Street 1:210 LEWIS ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2107
Practice Address - Country:US
Practice Address - Phone:715-425-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner