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General NPI Number Information
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NPI Number | 1194700815
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Entity Type | Individual
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Provider Name | SYRENA DANETTE GAMBLE CFA
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 625 MCGUIRE RD
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City | SYMSONIA
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State | KY
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Zip | 42082-9245
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Country | US
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Telephone | 270-519-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 625 MCGUIRE RD
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City | SYMSONIA
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State | KY
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Zip | 42082-9245
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Country | US
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Telephone | 270-519-7225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 93154
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License Number State | KY
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