MEDICARE: DUANE JOSEPH LAMPERT

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	364SA2100X	Acute Care Clinical Nurse Specialist	APRN.CNS.0019488	OH

General Provider Information

NPI Number	:	1811767775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE JOSEPH LAMPERT

Provider Business Mailing Address
First Line	:	264 WILMINGTON DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4450
Country	:	US
Telephone Number	:	360-621-1425
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-0375
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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