Provider Demographics
NPI:1164916300
Name:LAMBERT, ELLEN L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHEPPARD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-2284
Mailing Address - Country:US
Mailing Address - Phone:304-308-4358
Mailing Address - Fax:
Practice Address - Street 1:12301 GRAPEFIELD RD
Practice Address - Street 2:
Practice Address - City:BASTIAN
Practice Address - State:VA
Practice Address - Zip Code:24314-4547
Practice Address - Country:US
Practice Address - Phone:276-688-4331
Practice Address - Fax:276-688-4336
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily