Provider Demographics
NPI:1609223304
Name:LAMBERT, DEANNA
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
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 1:3 SAINT ELIZABETH BLVD STE 2800
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:618-233-6044
Mailing Address - Fax:833-973-4218
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 2800
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:618-233-6044
Practice Address - Fax:833-973-4218
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014413207RI0011X, 363L00000X, 363LA2100X
MO2016005211363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner