Healthcare Provider Details

I. General information

NPI: 1821467473
Provider Name (Legal Business Name): MACKENZIE RAEN LAMBERT CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAKENZIE RAEN DEGRAFF

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 500
RICHMOND VA
23226-1928
US

IV. Provider business mailing address

PO BOX 936952
ATLANTA GA
31193-6952
US

V. Phone/Fax

Practice location:
  • Phone: 804-297-3055
  • Fax: 804-297-3056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024172965
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172965
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: