Provider Demographics
NPI:1376740761
Name:LAMBERT, MARTIN EMERSON (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:EMERSON
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 LOOKOUT MTN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7045
Mailing Address - Country:US
Mailing Address - Phone:605-343-4562
Mailing Address - Fax:605-348-7277
Practice Address - Street 1:300 E 8TH ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-1123
Practice Address - Country:US
Practice Address - Phone:308-282-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered