Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 18165 | WV |
NPI | 1295737153 |
---|---|
Provider Name | Ms. Ann M. Lambernedis |
First Address | Huntington, WV 25703-1642 |
Second Address | Scott Depot, WV 25560-9548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0110154000 | (05) | WV |