Provider Demographics
NPI:1205048295
Name:GAMBLE, DAWN CAMILLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:CAMILLE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 BERMUDA CIR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-1608
Mailing Address - Country:US
Mailing Address - Phone:740-382-3247
Mailing Address - Fax:
Practice Address - Street 1:1042 BERMUDA CIR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1608
Practice Address - Country:US
Practice Address - Phone:740-382-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113098164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2695570Medicaid