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General NPI Number Information
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NPI Number | 1336782788
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Entity Type | Individual
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Provider Name | MICHELLE LAZARUS
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4201 GREENWOOD DR
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3250
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Country | US
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Telephone | 757-654-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 S LYNNHAVEN RD STE 450
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-8524
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Country | US
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Telephone | 757-560-6230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024178323
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License Number State | VA
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