Healthcare Provider Details

I. General information

NPI: 1538377080
Provider Name (Legal Business Name): ELDORA L LAZAROFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGBEE AVE NW
CANTON OH
44718-2522
US

IV. Provider business mailing address

4245 SKYCREST DR NW
CANTON OH
44718-2149
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-0313
  • Fax:
Mailing address:
  • Phone: 330-493-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN187782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: