Healthcare Provider Details

I. General information

NPI: 1770101446
Provider Name (Legal Business Name): CYNTHIA JANE LAZZARI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 MONTGOMERY RD
ELKRIDGE MD
21075-5414
US

IV. Provider business mailing address

12413 DETOUR RD
KEYMAR MD
21757-8821
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-5040
  • Fax:
Mailing address:
  • Phone: 301-367-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR138981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: