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General NPI Number Information
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NPI Number | 1780408492
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Entity Type | Individual
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Provider Name | ANNETTE GAMBRILL RN-BSN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2024
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 100 MEDICAL PLZ
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1366
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Country | US
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Telephone | 636-755-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MAGNOLIA WAY
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City | SILEX
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State | MO
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Zip | 63377-2487
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Country | US
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Telephone | 636-486-5045
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 2012019993
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License Number State | MO
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