Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1159 | ND |
NPI | 1083017370 |
---|---|
Provider Name | Mrs. Jennifer Lynn Lamp |
First Address | Fargo, ND 58102-4421 |
Second Address | Fargo, ND 58102-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 01/10/2014 |