MEDICARE: MRS. ANGELA MARIE LAMBERSON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L001745	NC

General Provider Information

NPI Number	:	1003838491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE LAMBERSON RD

Provider Business Mailing Address
First Line	:	1908 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9343
Country	:	US
Telephone Number	:	252-335-9355
Fax Number	:	844-965-9381

Provider Business Practice Location Address
First Line	:	1908 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9343
Country	:	US
Telephone Number	:	252-335-9355
Fax Number	:	844-965-9381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/25/2024

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