Provider Demographics
NPI:1043826787
Name:GAMBREL, JANICE P
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:P
Last Name:GAMBREL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 BRUMBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9538
Mailing Address - Country:US
Mailing Address - Phone:937-548-2540
Mailing Address - Fax:
Practice Address - Street 1:3390 BRUMBAUGH RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9538
Practice Address - Country:US
Practice Address - Phone:937-548-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1901339Medicaid