Provider Demographics
NPI:1801412713
Name:GAMBLE, JANELLE (LVN)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 PEPPERTREE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-1453
Mailing Address - Country:US
Mailing Address - Phone:510-557-3746
Mailing Address - Fax:
Practice Address - Street 1:9289 BRANSTETTER PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1700
Practice Address - Country:US
Practice Address - Phone:209-477-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA691945164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse