Healthcare Provider Details

I. General information

NPI: 1083247316
Provider Name (Legal Business Name): ANNA LAZZARO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-243-7277
  • Fax: 623-247-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number238291
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: