Healthcare Provider Details

I. General information

NPI: 1427158096
Provider Name (Legal Business Name): PATRICIA KELLY LAZAROFF RN, CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ MAILSTOP 90-21-400
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

58 BERKSHIRE DR
SAINT LOUIS MO
63117-1044
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-7882
  • Fax:
Mailing address:
  • Phone: 314-993-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number062047
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: