Healthcare Provider Details

I. General information

NPI: 1679493324
Provider Name (Legal Business Name): REBECCA LAZERSON DNP, APN, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

47 BRYANT RD
BLACKWOOD NJ
08012-1445
US

V. Phone/Fax

Practice location:
  • Phone: 445-326-8076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number26NJ15492100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: