Provider Demographics
NPI:1386412021
Name:LAMBETH, CONNIE JORDAN (CPM, LM)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:JORDAN
Last Name:LAMBETH
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1039
Mailing Address - Country:US
Mailing Address - Phone:608-609-1801
Mailing Address - Fax:
Practice Address - Street 1:4506 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-1039
Practice Address - Country:US
Practice Address - Phone:608-609-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife