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General NPI Number Information
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NPI Number | 1538989942
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Entity Type | Individual
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Provider Name | DUSTIN LAMB CRNP
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1520 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60622-1967
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Country | US
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Telephone | 312-283-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N WELLS ST APT 2108
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City | CHICAGO
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State | IL
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Zip | 60606-1341
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Country | US
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Telephone | 256-777-7800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.030763
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License Number State | IL
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