Provider Demographics
NPI:1427420272
Name:LAMBRECHT, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:LAMBRECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRUCE LATOURRETTE RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-3335
Mailing Address - Country:US
Mailing Address - Phone:607-865-5395
Mailing Address - Fax:
Practice Address - Street 1:12 BRUCE LATOURRETTE RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-3335
Practice Address - Country:US
Practice Address - Phone:607-865-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272157-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse