Healthcare Provider Details

I. General information

NPI: 1629755004
Provider Name (Legal Business Name): LYELA MARIE LAMBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 W WALNUT ST STE B
LAKE CHARLES LA
70601-5699
US

IV. Provider business mailing address

2918 CYPRESS ST
LAKE CHARLES LA
70601-8435
US

V. Phone/Fax

Practice location:
  • Phone: 337-287-9127
  • Fax:
Mailing address:
  • Phone: 337-292-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCLPL03226LAB
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: