Healthcare Provider Details

I. General information

NPI: 1265990451
Provider Name (Legal Business Name): PAULA MICHELLE LAZARSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 LAUREL BLVD STE 2
POTTSVILLE PA
17901-1415
US

IV. Provider business mailing address

1410 LAUREL BLVD STE 2
POTTSVILLE PA
17901-1415
US

V. Phone/Fax

Practice location:
  • Phone: 570-628-5374
  • Fax: 570-628-5809
Mailing address:
  • Phone: 570-628-5374
  • Fax: 570-628-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN233114L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: