Healthcare Provider Details

I. General information

NPI: 1891778239
Provider Name (Legal Business Name): NELLIE RIENDEAU LAZAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 MARKET ST. STE. 1371 CHOP ADOLESCENT INITIATIVE
PHILADELPHIA PA
19104-5021
US

IV. Provider business mailing address

3535 MARKET ST. STE. 1371 CHOP ADOLESCENT INITIATIVE
PHILADELPHIA PA
19104-5021
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3626
  • Fax: 215-590-0426
Mailing address:
  • Phone: 215-590-3626
  • Fax: 215-590-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP008400
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: