Healthcare Provider Details

I. General information

NPI: 1326876020
Provider Name (Legal Business Name): ANDREW RILEY LAZARCHIK APRN AGAC-CNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

V. Phone/Fax

Practice location:
  • Phone: 216-285-4146
  • Fax: 216-201-7110
Mailing address:
  • Phone: 216-285-4146
  • Fax: 216-201-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0037135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: