Healthcare Provider Details

I. General information

NPI: 1104606904
Provider Name (Legal Business Name): HEATH MANNING LAMB NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COLUMBUS AVE STE 380
BAY CITY MI
48708-6476
US

IV. Provider business mailing address

4 COLUMBUS AVE STE 380
BAY CITY MI
48708-6476
US

V. Phone/Fax

Practice location:
  • Phone: 989-393-2700
  • Fax:
Mailing address:
  • Phone: 989-393-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704275337
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704275337
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704275337
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704275337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: