Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN25551 | MT |
NPI | 1003016346 |
---|---|
Provider Name | Mrs. Patricia D Lamb |
First Address | Lolo, MT 59847-0215 |
Second Address | Missoula, MT 59801-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25551 | MT STATE LICENSE (01) | MT |