MEDICARE: JUDITH NM LAMARRE

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	363LP2300X	Primary Care Nurse Practitioner	A004701	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A004701	OTHER	AR	PROVIDER
2	A004701	OTHER	AR	NURSE PRACTITIONER
3	A004701	OTHER	AR	NP

General Provider Information

NPI Number	:	1528529369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH NM LAMARRE

Provider Business Mailing Address
First Line	:	604 TIMBERBROOK CIR
Second Line	:
City	:	MARION
State	:	AR
Zip	:	72364-2427
Country	:	US
Telephone Number	:	978-771-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 DALE BUMPERS DR
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2696
Country	:	US
Telephone Number	:	870-630-6000
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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