MEDICARE: SUSAN LAMB ANP

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	363LF0000X	Family Nurse Practitioner	774	AK
2	363LF0000X	Family Nurse Practitioner	APN.0996558-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1730113739	OTHER	PFMC CLINIC NPI
2	743109721	OTHER	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962575001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LAMB ANP

Provider Business Mailing Address
First Line	:	4212 GOLDENEYE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-3637
Country	:	US
Telephone Number	:	907-360-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 PENNCOCK PLACE #121
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80528-8052
Country	:	US
Telephone Number	:	970-495-8800
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	02/21/2022

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Directions to “ SUSAN LAMB ANP” Practice Location

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