Provider Demographics
NPI:1326140047
Name:LAMB, NANCY LOUISA (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LOUISA
Last Name:LAMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOT APPLICABLE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3636 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3022
Mailing Address - Country:US
Mailing Address - Phone:310-390-7902
Mailing Address - Fax:
Practice Address - Street 1:764 WALNUT KNOLL LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3113
Practice Address - Country:US
Practice Address - Phone:901-737-9196
Practice Address - Fax:901-758-2479
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA498772084N0400X
MS192662084N0400X
TN400542084S0012X
TXM32892084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A498770Medicaid
CA00A498770OtherBLUE SHIELD OF CA