Healthcare Provider Details

I. General information

NPI: 1134483886
Provider Name (Legal Business Name): DEBORAH LAMBERT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/02/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT STREET
SPRINGFIELD MA
01191-1001
US

IV. Provider business mailing address

908 ALLEN ST
SPRINGFIELD MA
01118-2533
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax:
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2278098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: