Provider Demographics
NPI:1932648904
Name:LAMAR, MADISON STURGEON (NP-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:STURGEON
Last Name:LAMAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5403
Mailing Address - Country:US
Mailing Address - Phone:731-513-1253
Mailing Address - Fax:
Practice Address - Street 1:1201 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5403
Practice Address - Country:US
Practice Address - Phone:731-513-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN185462163W00000X
TN22365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse