Basic Information
| Provider Information | |||||||||
| NPI: | 1063486041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMAR | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | FAYE | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8120 S CULLEN PL | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478029734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122363189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 123 N MCCREARY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRANCH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476481313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127531039 | ||||||||
| FaxNumber: | 8127531122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 71002084A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.