Provider Demographics
NPI:1215449228
Name:LAMB, ELIZABETH REITZEL (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REITZEL
Last Name:LAMB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2012
Mailing Address - Country:US
Mailing Address - Phone:508-556-3973
Mailing Address - Fax:508-556-3973
Practice Address - Street 1:1183 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2012
Practice Address - Country:US
Practice Address - Phone:508-556-3973
Practice Address - Fax:508-556-3973
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129783163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1144769167Medicaid