=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184935801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAMBERT HAROLD EVERSON CNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2010
-----------------------------------------------------
Last Update Date | 06/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1144 13TH ST
-----------------------------------------------------
City | HOLLY HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-682-5798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1144 13TH ST
-----------------------------------------------------
City | HOLLY HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-682-5798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | CNA 217770
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------