Healthcare Provider Details

I. General information

NPI: 1902172679
Provider Name (Legal Business Name): DELLA LAMBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11904 HUNTINGTON DR
FREDERIC MI
49733-9530
US

IV. Provider business mailing address

11904 HUNTINGTON DR
FREDERIC MI
49733-9530
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-3590
  • Fax:
Mailing address:
  • Phone: 231-487-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704211266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: