Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036092816 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036092816 | IL |
NPI | 1154334209 |
---|---|
Provider Name | Tondalaya L. Gamble |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 09/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60697 | (02) |