Healthcare Provider Details

I. General information

NPI: 1912076613
Provider Name (Legal Business Name): JOAN LAZAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NYE RD SUITE 102
GLASTONBURY CT
06033-1281
US

IV. Provider business mailing address

55 NYE RD SUITE 102
GLASTONBURY CT
06033-1281
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-3056
  • Fax: 860-633-3517
Mailing address:
  • Phone: 860-657-3056
  • Fax: 860-633-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000950
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: