Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2012001793 | MO |
NPI | 1003188285 |
---|---|
Provider Name | Ven Thi Lam |
First Address | Springfield, MO 65803-4306 |
Second Address | Springfield, MO 65803-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 02/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003188285 | (05) | MO |