Individual
CONNIE JO GAMBREL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
3924 S VILLAGE DRIVE, NEW PALESTINE, IN 46163
(317) 861-5436
(317) 861-5436
Mailing address
3924 S VILLAGE DRIVE, NEW PALESTINE, IN 46163
(317) 861-5436
(317) 861-5436
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
70000110A
IN
163WP0808X
Psychiatric/Mental Health Registered Nurse
28066452A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70000110A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100323760A
—
IN
Enumeration date
06/15/2006
Last updated
12/27/2019
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