Provider Demographics
NPI:1548992688
Name:GAMBO, JEAN (RN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GAMBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 HABERSHAM CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5757
Mailing Address - Country:US
Mailing Address - Phone:301-873-8423
Mailing Address - Fax:
Practice Address - Street 1:250 RICHARD MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1147
Practice Address - Country:US
Practice Address - Phone:240-740-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145546163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R145546OtherMARYLAND BOARD OF NURSING