Provider Demographics
NPI:1184174419
Name:GAMBRELL, CECILE (PERSONAL CARE WORKER)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:PERSONAL CARE WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100542
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-0542
Mailing Address - Country:US
Mailing Address - Phone:414-840-2893
Mailing Address - Fax:
Practice Address - Street 1:309 JOELLEN DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-4977
Practice Address - Country:US
Practice Address - Phone:920-791-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide