Healthcare Provider Details

I. General information

NPI: 1548992688
Provider Name (Legal Business Name): JEAN GAMBO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RICHARD MONTGOMERY DR
ROCKVILLE MD
20852-1147
US

IV. Provider business mailing address

14913 HABERSHAM CIR
SILVER SPRING MD
20906-5757
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-6102
  • Fax:
Mailing address:
  • Phone: 301-873-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR145546
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: