Healthcare Provider Details

I. General information

NPI: 1053468579
Provider Name (Legal Business Name): DONA MARIE GAMBREL APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 SOUTHWEST FWY
HOUSTON TX
77074-1407
US

IV. Provider business mailing address

210 BAYLAND AVE
HOUSTON TX
77009-6715
US

V. Phone/Fax

Practice location:
  • Phone: 713-448-6986
  • Fax: 713-448-5746
Mailing address:
  • Phone: 713-426-2862
  • Fax: 713-448-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number431278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: