Provider Demographics
NPI:1255518817
Name:GAMBARDELLA, SHERYL ANN (NP)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:ANN
Last Name:GAMBARDELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3873
Mailing Address - Country:US
Mailing Address - Phone:575-461-7901
Mailing Address - Fax:575-461-8573
Practice Address - Street 1:309 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3873
Practice Address - Country:US
Practice Address - Phone:575-461-7901
Practice Address - Fax:575-461-8728
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01374363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81538570Medicaid
NM301413Medicare PIN