Healthcare Provider Details

I. General information

NPI: 1063486041
Provider Name (Legal Business Name): CAROLYN FAYE LAMAR ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MCCREARY ST
FORT BRANCH IN
47648-1313
US

IV. Provider business mailing address

8120 S CULLEN PL
TERRE HAUTE IN
47802-9734
US

V. Phone/Fax

Practice location:
  • Phone: 812-753-1039
  • Fax: 812-753-1122
Mailing address:
  • Phone: 812-236-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71002084A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: