Provider Demographics
NPI:1831912237
Name:LAMB, LEANNE VANESSA (MSN, RN, AGNP-C)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:VANESSA
Last Name:LAMB
Suffix:
Gender:F
Credentials:MSN, RN, AGNP-C
Other - Prefix:
Other - First Name:LEAN VANESSA
Other - Middle Name:TUVERA
Other - Last Name:RIDAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:18724 128TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6186
Mailing Address - Country:US
Mailing Address - Phone:510-364-9164
Mailing Address - Fax:
Practice Address - Street 1:1427 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-262-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61624561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61624561OtherWA DOH ARNP LICENSE