Provider Demographics
NPI:1174587752
Name:LAMAR, EDELTRAUD KATHE (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:EDELTRAUD
Middle Name:KATHE
Last Name:LAMAR
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MRS
Other - First Name:EDIE
Other - Middle Name:K
Other - Last Name:LAMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:165 SWEET GUM LN
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7810
Mailing Address - Country:US
Mailing Address - Phone:803-648-0151
Mailing Address - Fax:803-648-0151
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-3989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151178 NP363LF0000X
SC1027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily