Healthcare Provider Details

I. General information

NPI: 1285189969
Provider Name (Legal Business Name): TIMOTHY HEATH LAMBERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BISHOPS PARK DR UNIT 308
RALEIGH NC
27605-1250
US

IV. Provider business mailing address

700 BISHOPS PARK DR UNIT 308
RALEIGH NC
27605-1250
US

V. Phone/Fax

Practice location:
  • Phone: 336-944-2205
  • Fax:
Mailing address:
  • Phone: 336-944-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number113382
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: