Provider Demographics
NPI:1568511236
Name:LAMP, REBECCA L (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:LAMP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 DERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-9711
Mailing Address - Country:US
Mailing Address - Phone:304-797-8207
Mailing Address - Fax:
Practice Address - Street 1:75 AVENUE B
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1236
Practice Address - Country:US
Practice Address - Phone:304-846-2573
Practice Address - Fax:304-846-9562
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125469XRNMedicare PIN
PA125469XRUMedicare PIN