Healthcare Provider Details

I. General information

NPI: 1962575001
Provider Name (Legal Business Name): SUSAN LAMB ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/21/2022
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PENNCOCK PLACE #121
FT COLLINS CO
80528-8052
US

IV. Provider business mailing address

4212 GOLDENEYE DR
FORT COLLINS CO
80526-3637
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8800
  • Fax:
Mailing address:
  • Phone: 907-360-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number774
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996558-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: