Provider Demographics
NPI:1235738865
Name:LAMBERT, LEANNA J
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:J
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 18TH ST S APT 201
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5907
Mailing Address - Country:US
Mailing Address - Phone:701-219-3045
Mailing Address - Fax:
Practice Address - Street 1:520 31ST AVE N APT 11
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1556
Practice Address - Country:US
Practice Address - Phone:701-561-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1470788Medicaid