Basic Information
| Provider Information | |||||||||
| NPI: | 1962991273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAMBLE | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | AEMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012615 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893612 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2018 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146M00000X | Y | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate |
ID Information
| ID | Type | State | Issuer | Description | 71675 | 01 | NV | AEMT | OTHER |