Healthcare Provider Details

I. General information

NPI: 1962991273
Provider Name (Legal Business Name): RODNEY L GAMBLE AEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 AVENUE H
ELY NV
89301-2615
US

IV. Provider business mailing address

1500 AVENUE H
ELY NV
89301-2615
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: