Provider Demographics
NPI:1578230991
Name:LAMB, MADISON KAELIN (RN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAELIN
Last Name:LAMB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BALBOA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-4651
Mailing Address - Country:US
Mailing Address - Phone:865-384-9443
Mailing Address - Fax:
Practice Address - Street 1:113 BALBOA DR
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4651
Practice Address - Country:US
Practice Address - Phone:865-384-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93520163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN93520OtherSTATE OF TENNESSEE DEPARTMENT OF HEALTH