Healthcare Provider Details

I. General information

NPI: 1699921981
Provider Name (Legal Business Name): JANICE LYNN LAZEAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W FAIRVIEW AVE
JOHNSON CITY TN
37604-5611
US

IV. Provider business mailing address

365 STOUT DRIVE BOX 70403
JOHNSON CITY TN
37614
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-4225
  • Fax: 423-439-7371
Mailing address:
  • Phone: 423-439-4515
  • Fax: 423-439-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR117674
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: