Healthcare Provider Details

I. General information

NPI: 1538989942
Provider Name (Legal Business Name): DUSTIN LAMB CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N DAMEN AVE
CHICAGO IL
60622-1967
US

IV. Provider business mailing address

210 N WELLS ST APT 2108
CHICAGO IL
60606-1341
US

V. Phone/Fax

Practice location:
  • Phone: 312-283-5560
  • Fax:
Mailing address:
  • Phone: 256-777-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: