Healthcare Provider Details

I. General information

NPI: 1306523337
Provider Name (Legal Business Name): RHIANNON MARIE LAZEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/21/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 HWY 441N SUITE 310A
OKEECHOBEE FL
34972
US

IV. Provider business mailing address

345 BANYAN BLVD UNIT 408
WEST PALM BEACH FL
33401-4651
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-1510
  • Fax:
Mailing address:
  • Phone: 412-526-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: