Healthcare Provider Details

I. General information

NPI: 1235125675
Provider Name (Legal Business Name): CHERYL K GAMBLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYNN KIRKPATRICK

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST 3RD FLOOR
WILMINGTON DE
19805-3518
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-4330
  • Fax: 302-421-4331
Mailing address:
  • Phone: 302-733-0705
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0019365
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00391
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN305816L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: