Provider Demographics
NPI:1962575001
Name:LAMB, SUSAN (ANP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 GOLDENEYE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3637
Mailing Address - Country:US
Mailing Address - Phone:907-360-6968
Mailing Address - Fax:
Practice Address - Street 1:1025 PENNCOCK PLACE #121
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8052
Practice Address - Country:US
Practice Address - Phone:970-495-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK774363LF0000X
COAPN.0996558-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730113739OtherPFMC CLINIC NPI
743109721OtherTAX ID
AKNP99111Medicaid
1730113739OtherPFMC CLINIC NPI