Provider Demographics
NPI:1972298073
Name:LAMB, NICOLE L (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:LAMB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11749 ROAD 132
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9260
Mailing Address - Country:US
Mailing Address - Phone:419-670-3445
Mailing Address - Fax:
Practice Address - Street 1:800 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4611
Practice Address - Country:US
Practice Address - Phone:419-783-2207
Practice Address - Fax:419-783-2218
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.146706.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty