1124070297 NPI number — MRS. JULIA LYNN GAMBLE ARNP

Table of content: MICHAEL JOHN TUCIBAT (NPI 1417003807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124070297 NPI number — MRS. JULIA LYNN GAMBLE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBLE
Provider First Name:
JULIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRINGTON
Provider Other First Name:
JULIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124070297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 JULIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEPPERELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01463-1482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-275-9175
Provider Business Mailing Address Fax Number:
781-275-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SPRINGS RD
Provider Second Line Business Practice Location Address:
BLD 8, 2ND FLOOR
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01730-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-275-9175
Provider Business Practice Location Address Fax Number:
781-275-9829
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP2201X , with the licence number:  262461 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)