Provider Demographics
NPI:1174510838
Name:LAMB, HEATHER H (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:LAMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3059
Mailing Address - Fax:641-428-2080
Practice Address - Street 1:1421 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2856
Practice Address - Country:US
Practice Address - Phone:641-428-2080
Practice Address - Fax:641-428-5150
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066424363A00000X
IA002304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8807OtherBC/BS
TX8N8807OtherBC/BS
Q48982Medicare UPIN