Provider Demographics
NPI:1912980459
Name:LANHAM, MARY CEIL (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CEIL
Last Name:LANHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-583-5836
Mailing Address - Fax:502-583-2266
Practice Address - Street 1:100 E LIBERTY ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1434
Practice Address - Country:US
Practice Address - Phone:502-583-5836
Practice Address - Fax:502-583-2266
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500021552OtherRAILROAD MEDICARE
KY1152481OtherPASSPORT
KY000000214606OtherANTHEM BCBS
KY78003126Medicaid
KY500021552OtherRAILROAD MEDICARE
KY1152481OtherPASSPORT