Healthcare Provider Details

I. General information

NPI: 1699348573
Provider Name (Legal Business Name): PETER GUNNAR RAMBO JR. AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LANGHORNE RD STE 202
LYNCHBURG VA
24501-1402
US

IV. Provider business mailing address

2050 LANGHORNE RD STE 202
LYNCHBURG VA
24501-1402
US

V. Phone/Fax

Practice location:
  • Phone: 434-623-9680
  • Fax: 434-302-9812
Mailing address:
  • Phone: 434-623-9680
  • Fax: 434-302-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number25160
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number25160
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024195206
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5015957
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25160
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: