Healthcare Provider Details

I. General information

NPI: 1346252475
Provider Name (Legal Business Name): NICHOLAS EUGENE LAMBERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2103
US

IV. Provider business mailing address

PO BOX 11225
CHATTANOOGA TN
37401-2225
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-7608
  • Fax: 423-778-2360
Mailing address:
  • Phone: 423-892-9483
  • Fax: 423-899-0928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN139654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: