Healthcare Provider Details

I. General information

NPI: 1720503881
Provider Name (Legal Business Name): JENNIFER ELAINE LAZZARA DNP, APRN, WHNP-BC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 S GREEN ST STE 400
MURRAY UT
84123-4740
US

IV. Provider business mailing address

3040 E CASTO LN
SALT LAKE CITY UT
84117-7160
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-2614
  • Fax:
Mailing address:
  • Phone: 801-442-2647
  • Fax: 385-297-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61131467
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5842552-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5842552-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: