Provider Demographics
NPI:1114355518
Name:LAMBERT, MARY CAROLINE (CSFA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLINE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DIETLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 W FAIRLANE CT
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-7094
Mailing Address - Country:US
Mailing Address - Phone:918-906-6203
Mailing Address - Fax:
Practice Address - Street 1:32 W FAIRLANE CT
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-7094
Practice Address - Country:US
Practice Address - Phone:918-906-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122922246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist