Healthcare Provider Details

I. General information

NPI: 1972621183
Provider Name (Legal Business Name): MICHELE ANN GAMBLE DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E VINE ST
SALISBURY MD
21804-5531
US

IV. Provider business mailing address

200 E VINE ST
SALISBURY MD
21804-5531
US

V. Phone/Fax

Practice location:
  • Phone: 443-358-6445
  • Fax: 443-973-6886
Mailing address:
  • Phone: 443-358-6445
  • Fax: 443-973-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00076800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001473
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000760
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: