Healthcare Provider Details

I. General information

NPI: 1417307489
Provider Name (Legal Business Name): GRETCHEN NICOLL GIMBEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAINE ST STE E101
BRUNSWICK ME
04011-3310
US

IV. Provider business mailing address

329 MAINE ST STE E101
BRUNSWICK ME
04011-3310
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-2266
  • Fax: 207-910-4413
Mailing address:
  • Phone: 207-373-2266
  • Fax: 207-910-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1737
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: