Healthcare Provider Details

I. General information

NPI: 1003121674
Provider Name (Legal Business Name): WILMOT LAMBERT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 PINEVIEW COVE CT
MONTGOMERY TX
77316-3220
US

IV. Provider business mailing address

149 PINEVIEW COVE CT
MONTGOMERY TX
77316-3220
US

V. Phone/Fax

Practice location:
  • Phone: 936-548-6598
  • Fax:
Mailing address:
  • Phone: 936-548-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number338439-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number1058952
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005636
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number611372
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: