Healthcare Provider Details

I. General information

NPI: 1003968728
Provider Name (Legal Business Name): GRACE V LAMBERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HMEDDAC
APO AE
09042
DE

IV. Provider business mailing address

CMR 420 BOX 244
APO AE
09063
DE

V. Phone/Fax

Practice location:
  • Phone: 011496221172177
  • Fax:
Mailing address:
  • Phone: 011496224172295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number691457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: