Provider Demographics
NPI:1447537501
Name:GAMBLE, TERESA JENINE (LPN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JENINE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:JENINE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11701 JESSE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6211
Mailing Address - Country:US
Mailing Address - Phone:216-441-4045
Mailing Address - Fax:
Practice Address - Street 1:11701 JESSE AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6211
Practice Address - Country:US
Practice Address - Phone:216-441-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145823164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse