Healthcare Provider Details

I. General information

NPI: 1710423199
Provider Name (Legal Business Name): MARY LAMBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax:
Mailing address:
  • Phone: 443-244-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR089671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: