Provider Demographics
NPI:1841898111
Name:PICCOLO-LAMBERG, ALEXIS CHARRISSMA
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CHARRISSMA
Last Name:PICCOLO-LAMBERG
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 1:1421 E MURPHYS LN
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2992
Mailing Address - Country:US
Mailing Address - Phone:909-699-5095
Mailing Address - Fax:
Practice Address - Street 1:1421 E MURPHYS LN
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-2992
Practice Address - Country:US
Practice Address - Phone:909-699-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator