Provider Demographics
NPI:1104667823
Name:LAMBERT, ANDREA LAUREN (RN, BSN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LAUREN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LAUREN
Other - Last Name:LYSTILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:65 KRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-2210
Mailing Address - Country:US
Mailing Address - Phone:978-340-0750
Mailing Address - Fax:
Practice Address - Street 1:65 KRANTZ RD
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-2210
Practice Address - Country:US
Practice Address - Phone:978-340-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2344814163WX1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care