Basic Information
Provider Information
NPI: 1841835766
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBERT
FirstName: MICHAELA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: CNM, WHNP
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2051 JOHN JONES RD
Address2:  
City: DAVIS
State: CA
PostalCode: 956169701
CountryCode: US
TelephoneNumber: 5307582060
FaxNumber:  
Practice Location
Address1: 2051 JOHN JONES RD
Address2:  
City: DAVIS
State: CA
PostalCode: 956169701
CountryCode: US
TelephoneNumber: 5307582060
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/14/2019
LastUpdateDate: 09/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X95013282CAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
367A00000X236077CAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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