Provider Demographics
NPI:1861138513
Name:GAMBLE, ADVADELLA (RN)
Entity type:Individual
Prefix:MRS
First Name:ADVADELLA
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ADVADELLA
Other - Middle Name:
Other - Last Name:LILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:18 MARIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211
Mailing Address - Country:US
Mailing Address - Phone:518-221-6980
Mailing Address - Fax:
Practice Address - Street 1:18 MARIA DRIVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211
Practice Address - Country:US
Practice Address - Phone:518-221-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494295-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty