1659513976 NPI number — MRS. MOLLY PATRICIA GAMBLE LMP

Table of content: MRS. MOLLY PATRICIA GAMBLE LMP (NPI 1659513976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659513976 NPI number — MRS. MOLLY PATRICIA GAMBLE LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBLE
Provider First Name:
MOLLY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659513976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 E WHIDBEY AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
OAK HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-387-9419
Provider Business Mailing Address Fax Number:
360-323-4151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 E WHIDBEY AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
OAK HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-387-9419
Provider Business Practice Location Address Fax Number:
360-323-4151
Provider Enumeration Date:
04/01/2009

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: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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