Healthcare Provider Details

I. General information

NPI: 1265216220
Provider Name (Legal Business Name): SHANNON GAMBEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E ELLIOT RD
GILBERT AZ
85234-6924
US

IV. Provider business mailing address

3522 E SPRING WHEAT LN
GILBERT AZ
85296-0650
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-0177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN137267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: