Provider Demographics
NPI:1912952029
Name:LAMB, JEANETTE NICOLE (CNM)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:NICOLE
Last Name:LAMB
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CALL PLACE
Mailing Address - Street 2:STE 100H
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4990
Mailing Address - Country:US
Mailing Address - Phone:208-261-4233
Mailing Address - Fax:833-471-4276
Practice Address - Street 1:1175 CALL PLACE
Practice Address - Street 2:STE 100H
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4990
Practice Address - Country:US
Practice Address - Phone:208-261-4233
Practice Address - Fax:833-471-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNM-42367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010155086OtherREGENCE BLUE SHIELD OF ID
IDNPYT9OtherBLUE CROSS OF IDAHO
ID807386400Medicaid
IDP00347141OtherRAILROAD MEDICARE
IDP00347141OtherRAILROAD MEDICARE
ID1305232Medicare PIN
IDNPYT9OtherBLUE CROSS OF IDAHO