Provider Demographics
NPI:1780408492
Name:GAMBRILL, ANNETTE (RN-BSN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GAMBRILL
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:SILEX
Mailing Address - State:MO
Mailing Address - Zip Code:63377-2487
Mailing Address - Country:US
Mailing Address - Phone:636-486-5045
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1366
Practice Address - Country:US
Practice Address - Phone:636-755-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019993163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical