Healthcare Provider Details

I. General information

NPI: 1508986613
Provider Name (Legal Business Name): CAROLYN A LAZAROWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 SLOAN RD
BIRCH RUN MI
48415-8934
US

IV. Provider business mailing address

505 PATTERSON AVE
BAY CITY MI
48706-4192
US

V. Phone/Fax

Practice location:
  • Phone: 989-746-9633
  • Fax: 989-746-9634
Mailing address:
  • Phone: 989-746-9633
  • Fax: 989-746-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704184286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: