Provider Demographics
NPI:1780998765
Name:LAM, NIDA N (NP)
Entity type:Individual
Prefix:
First Name:NIDA
Middle Name:N
Last Name:LAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-0626
Mailing Address - Country:US
Mailing Address - Phone:781-595-7348
Mailing Address - Fax:781-598-3583
Practice Address - Street 1:694 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2229
Practice Address - Country:US
Practice Address - Phone:781-595-7348
Practice Address - Fax:781-598-3583
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN268284163WC0400X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0400XNursing Service ProvidersRegistered NurseCase Management