Provider Demographics
NPI:1043450844
Name:GAMBINI, LISA SHEA (DEM)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SHEA
Last Name:GAMBINI
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 KERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-3144
Mailing Address - Country:US
Mailing Address - Phone:570-352-3325
Mailing Address - Fax:484-214-0217
Practice Address - Street 1:58 KERNWOOD DR
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-3144
Practice Address - Country:US
Practice Address - Phone:570-352-3325
Practice Address - Fax:484-214-0217
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife