Basic Information
Provider Information
NPI: 1003016346
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMB
FirstName: PATRICIA
MiddleName: D
NamePrefix: MRS.
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 215
Address2:  
City: LOLO
State: MT
PostalCode: 598470215
CountryCode: US
TelephoneNumber: (406) 926-1109
FaxNumber: 4069261267
Practice Location
Address1: 715 KENSINGTON AVE STE 16
Address2:  
City: MISSOULA
State: MT
PostalCode: 598015700
CountryCode: US
TelephoneNumber: (406) 926-1109
FaxNumber: 4069261267
Other Information
ProviderEnumerationDate: 07/24/2007
LastUpdateDate: 04/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN25551MTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
2555101MTMT STATE LICENSEOTHER


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