Healthcare Provider Details

I. General information

NPI: 1982804357
Provider Name (Legal Business Name): KATHRYN P LAMBOURNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 HOLY CROSS PARKWAY ST. JOSEPH REGIONAL MEDICAL CENTER - ANESTHESIA DEPT
MISHAWAKA IN
53792-0001
US

IV. Provider business mailing address

121 S. ST LOUIS BLVD ST. JOSEPH VALLEY ANESTHESIA
SOUTH BEND IN
46617
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 574-233-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01069656A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: