Provider Demographics
NPI:1841551033
Name:GAMBLE, JUSTINE N (FNP)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:N
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N BEALE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6937
Mailing Address - Country:US
Mailing Address - Phone:530-743-6888
Mailing Address - Fax:
Practice Address - Street 1:1908 N BEALE RD STE E
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6937
Practice Address - Country:US
Practice Address - Phone:530-743-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797849163W00000X
CA95031365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse