MEDICARE: MRS. EDELTRAUD KATHE LAMAR APRN-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN151178 NP	GA
2	363LF0000X	Family Nurse Practitioner	1027	SC

General Provider Information

NPI Number	:	1174587752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EDELTRAUD KATHE LAMAR APRN-BC

Provider Business Mailing Address
First Line	:	165 SWEET GUM LN
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-7810
Country	:	US
Telephone Number	:	803-648-0151
Fax Number	:	803-648-0151

Provider Business Practice Location Address
First Line	:	1 FREEDOM WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-6258
Country	:	US
Telephone Number	:	706-733-0188
Fax Number	:	706-823-3989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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