Provider Demographics
NPI:1306176326
Name:GAMBO, JOANNE (CRNP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:GAMBO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E BEECHWOOD AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1363
Mailing Address - Country:US
Mailing Address - Phone:856-858-2287
Mailing Address - Fax:
Practice Address - Street 1:34TH ST AND CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:08107
Practice Address - Country:US
Practice Address - Phone:856-858-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUPOO5998D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics