Provider Information for 1467129460
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NICOLE LEMBO MA
Sex: Female
NPI: 1467129460
Last Updated: 2024-05-13
Certification Date: 2024-05-13
Certification Date: 2024-05-13
Details
Name | Value | ||||||||||||||
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NPI | 1467129460 | ||||||||||||||
Enumeration Date | 2021-08-26 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | NO | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 2801 BERTHOLET BLVD STE 301 VALPARAISO, IN 46383-7959 United States Phone: 219-323-3311 | Fax: | ||||||||||||||
Primary Practice Address | 1265 S LAKE PARK AVE HOBART, IN 46342-5961 United States Phone: 219-323-3311 | Fax: | ||||||||||||||
Secondary Practice Address(es) | 2801 BERTHOLET BLVD STE 301 | ||||||||||||||
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