Provider Demographics
NPI:1427444090
Name:LAMBERTSEN, NICHOLAS SCOTT (ATC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:LAMBERTSEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 1/2 N 500 E
Mailing Address - Street 2:APT 8
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4255
Mailing Address - Country:US
Mailing Address - Phone:435-632-9987
Mailing Address - Fax:
Practice Address - Street 1:353 1/2 N 500 E
Practice Address - Street 2:APT 8
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4255
Practice Address - Country:US
Practice Address - Phone:435-632-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT874615348102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer