Provider Demographics
NPI:1982804357
Name:LAMBOURNE, KATHRYN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:P
Last Name:LAMBOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 S. ST LOUIS BLVD
Mailing Address - Street 2:ST. JOSEPH VALLEY ANESTHESIA
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:574-233-3125
Practice Address - Street 1:5215 HOLY CROSS PARKWAY
Practice Address - Street 2:ST. JOSEPH REGIONAL MEDICAL CENTER - ANESTHESIA DEPT
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:574-335-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069656A207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program