Provider Demographics
NPI:1003188285
Name:LAM, VEN THI (FNP)
Entity Type:Individual
Prefix:
First Name:VEN
Middle Name:THI
Last Name:LAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VEN
Other - Middle Name:THI
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2828 N NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4306
Mailing Address - Country:US
Mailing Address - Phone:417-837-4000
Mailing Address - Fax:417-875-4720
Practice Address - Street 1:2828 N NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4306
Practice Address - Country:US
Practice Address - Phone:417-837-4000
Practice Address - Fax:417-875-4720
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1003188285Medicaid
MO501150028Medicare PIN